الفهرس 
ACKNOWLEDGMENTSOnly 14 pages are availabe for public view
 |  | from | 167 |  |  |
| | | from | 167 | | |
Abstract
Summary
Of the entire maternity care cycle, the postpartum period occupies the lowest priority in practice, teaching, and research. Despite this, data from research outside the United States show that health problems after birth are very common, may persist over time, and are often under-recognized by care providers. The health of mothers after C.S has been described as a particular area of neglect (Allen, 2005). Major & minor health problems after childbirth are frequently under-reported to health professionals and sometimes primary care providers do not discuss common postnatal problems with women. Prolonged maternal recovery, restricted mobility and other minor health problems after C.S have also been reported (Michel, 2010).
The aim of this study was to identify postpartum health problems experienced by women delivered by Cesarean Section and her newborn, and to propose a nursing protocol to meet the needs of the post cesarean women during the puerperium.
The study was conducted in the postpartum wards of ObstetriC.S Department, Women’s Health Center, Assiut University Hospital, Egypt.
A prospective study design for determination of postoperative complications following C.S used for this study was utilized in this study.
This prospective study comprised 330 puerperal women admitted to the postpartum wards after Cesarean delivery. The study started at the beginning of January 2010 to the end of June 2010; follow up of the cases ended in the end of July 2010.
Data collection was done through the use of three types of tools structured interviewing sheet (Annex 1) was designed, validated and utilized by the researcher to be completed from every women admitted to postpartum department after C.S delivery. The data collected in the record included the following parts: (demographic data, obstetrical data, and outcomes of previous deliveries data, current antenatal condition data, and current C.S delivery data. Immediate postpartum assessment sheet: (Annex II) to collect data related to the condition of the woman immediately after delivery i.e. during the fourth stage of labor; until patient’s discharge, as vital signs, intake and output, general and local condition of the mother as well as her new born, and follow up sheet: (Annex III) to record data related to postoperative period and any complications that have arisen during the first postnatal visit (12 day of the puerperium) and second visit (40 Day of the puerperium). Follow up included patient’s condition (vital signs, breasts, wound, uterus, lochia, perineum, lower extremities and elimination) and problems encountered. Also, newborn assessment, included assessment of vital signs, head, chest, abdomen, genitalia and skin condition. Then the proposed protocol was discussed with the mothers and tailored according to each mother and newborn needs.
The results of the study revealed the following findings:
• The mean age of women was 25.85+4.8 years, the highest percentage of them had secondary or university education (51.5%), They mostly were housewives (91.5%) and living in rural areas (72.7%).
• Almost half (50.0%) of women were primigravida, 14.8% had past history of one to two abortions, and (1.5%) had a history of still birth.
• About 67.2% of women had previous cesarean section, spacing between the last cesarean section and the present one, it was 2-3year in the majority of them (55.9%).
• The gestational age of puerperal women ranged between (28-42 weeks ) with a mean of 38.945+1.457. The majority (65.7%) of women had normal pregnancy and only 34.3% had high risk pregnancy.
• Repeated C.S was the most common indications with the highest percentage (33.6%), followed by fetal distress (21.5%) and failure of labor progress(8.2%).
• More than two thirds (61.8%) of cesarean sections were emergency, and the great majority of C.S done under spinal anaesthesia (88.5%)
• As for C.S orders about more than one third of women underwent C.S for the second time (38.2%) followed by (32.7%) of them had C.S for the first time.
• More than half of the newborns (62.2%) were below the normal weight (2500 gm) and more than one tenth (11.2%) and 4.5% of them their Apgar score at one and fifth minute were less than 7.
• Less than one fifth (16.4%) of the newborns were admitted to PCU, and more than one fourth (25.8%) of women failed to initiate breast feeding within the first 24 hours after labor.
• Percentage of intra-operative complications was 15.8%, mostly 4.6% had bleeding and only 2 women (0.6%) had bladder injury, an equal proportion (0.3%) had anesthetic complications and rupture uterus.
• The incidence of early major postoperative health problems occurred among (31.2%) of women mostly postpartum fever (16.7%) followed by 5.8% were in need for blood transfusion and 4.5% exposed to chest infection
• The mean duration of hospital stay was 2.45+1.375 days
• Only 36.0% of women were satisfied with nursing care.
• Major health problems encountered among one third (32.4%) of C.S puerperal women during their first postnatal visit, mostly the urinary tract infection (11.5%), followed by wound infection (7.3%) and puerperal pyrexia (3.3%).
• Nearly one fourth of the studied women (25.4%) complained of major health problems during their second postnatal visit The most common types of these problems were the urinary tract infection (3.7%) followed by an equal proportion of wound infection & puerperal pyrexia (2.7% & 2.7% respectively).
• The incidence of minor health problems during hospitalization was 94.5% mostly the general problems (79.1%) followed by GIT problems (75.2%) and about one half of the women had an incision problems 49.4%.
• As regards the incidence of minor health problems during first postnatal visit occurred among 88.8% of C.S puerperal women, mostly general problems (68.8%) followed by muscle skeletal problems (62.4%), incisional problems(55.5%) and breast problems (32.4%).
• Almost three quarters of the studied women (74.2%) suffered from minor health problems during 2nd postnatal visit. mostly (44.1%) complained of general problems, followed by muscle skeletal problems (33.9%) and incisional problems (18.6%).
• During hospitalization more than half (52.1%)of newborns had problems. The most commonly reported problems were that of physiological jaundice (22.1%) followed by respiratory problems (20.6%), Gastrointestinal problems (10%) as vomiting and Congenital anomalies (1.8%).
• During 1st postnatal visit more than two thirds of newborns (70.9%) had problems, and 7 (2.2%) of newborns were died. The most commonly reported problems were that of GIT problems (39.3%) followed by respiratory problems (20.0%), jaundice (9.6%) and cord problems.
It was recommended to implement a development program for maternity nurse, to raise their awareness about early detection and identification of risk factors and complications of C.S. Provide individualized care during prenatal, natal and postnatal periods to prevent complications. Periodical educational classes for parturient women are suggested. Activate the follow up program for women in postpartum about care needed during postpartum period and postpartum health problems for the mother and newborn related to this expected problems and how alleviate it. Display an educational video during the waiting hours to inform mothers to be about hygienic care, nutrition, sleep and baby care.
Also, it was recommended to conduct further research in different settings to form an evidence based practice..