Table 1

Normal Postpartum Changes :

Parameter First 24 h First 3–4 days 5 days–2 wk After 2 wk

Clinical
Heart rate Starts Decreased to Baseline Baseline
decreasing baseline
Temperature Slightly Usually baseline Baseline Baseline
elevated
Vaginal Bloody (lochia Bloody (lochia Pale brown (lochia Pale brown to
discharge rubra) rubra) serosa)* yellowish white
(lochia alba)
Urine volume Increased Increased Decreasing to Baseline
Baseline
Uterus Begins Continues Firm, no longer Not palpable in
involution involution tender abdomen

Located about
midway between
symphysis and
umbilicus
Mood Baby blues Baby blues Normal by 7 to 10 Baseline
days
Breasts (if not Slightly Engorged Decreasing Baseline
breastfeeding) enlarged
Ovulation (in Unlikely Unlikely Unlikely Unlikely but
nonlactating
women) possible
Laboratory
WBC count Up to 20,000– Decreasing Decreasing to Baseline
30,000/μL baseline

Plasma Elevated Elevated Decreasing to Baseline

fibrinogen normal after 7 days

ESR
*Placental site sloughing may result in blood loss of about 250 mL at 7–14 days.
Managing Normal Labor and Delivery
Usually women give birth without serious
problems. Regardless of who assists them,
delivery care for these women involves:
* Providing a clean environment and
instruments and carefully washing hands and
fingernails before assisting the woman.
* Avoiding harmful practices such as pulling
on the umbilical cord to deliver the placenta,
performing vaginal examinations with dirty
hands, or cutting the umbilical cord with a
dirty implement.
* Helping the woman feel as comfortable as
possible.
* Physically assisting the woman during
birth--for example, positioning her to make
Expanded Program on Immunization
The Expanded Program on Immunization
(EPI) in the Philippines began in July 1979.
And, in 1986, made a response to the
Universal Child Immunization goal. The four
major strategies include:
1. Sustaining high routine Full
Immunized Child (FIC) coverage of at
least 90% in all provinces and cities,
2. Sustaining the polio-free country for
global certification
3. Eliminating measles by 2008,
4. Eliminating neonatal tetanus by 2008.
pushing easier, slowly easing the infant's
head out of the vaginal opening, and checking
the placenta after delivery to make sure
that it is complete.
* Having women breastfeed immediately
after delivery
Managing High-Risk Labor and Delivery
Women at high risk of complications can
deliver in community maternity centers if
necessary, although delivery in a well-
equipped hospital would be safer. If these
women have problems, assistant nurse-
midwives or midwives who staff maternity
centers can monitor them closely. These
practitioners can arrange transportation
quickly, stabilize women before transporting
them, and possibly talk by radio or telephone
with medical staff at the referral center.
Routine Schedule of Immunization
Every Wednesday is designated as
immunization day and is adopted in all parts
of the country. Immunization is done
monthly in barangay health stations,
quarterly in remote areas of the country.
Routine Immunization Schedule for Infants

The standard routine immunization schedule
for infants in the Philippines is adopted to
provide maximum immunity against the seven
vaccine preventable diseases in the country
before the child's first birthday. The fully
immunized child must have completed BCG 1,
DPT 1, DPT 2, DPT 3, OPV 1, OPV 2, OPV 3,
HB 1, HB 2, HB 3 and measles vaccines
before the child is 12 months of age.

Tetanus Toxoid Immunization Schedule

for Women
When given to women of childbearing age, vaccines
that contain tetanus toxoid (TT or Td)not only
protect women against tetanus, but also
prevent neonatal tetanus in their newborn infants.

Percent
Minimum
Vaccine Protecte Duration of Protection
Age/Interval
d

As early as possible
TT1 -- --
during pregnancy

 infants born to the mother will be protected from neonatal

At least 4 weeks tetanus
TT2 80%
later  gives 3 years protection for the mother

 infants born to the mother will be protected from neonatal

At least 6 months tetanus
TT3 95%
later  gives 5 years protection for the mother

 infants born to the mother will be protected from neonatal

tetanus
TT4 At least 1 year later 99%
 gives 10 years protection for the mother

 gives lifetime protection for the mother

TT5 At least 1 year later 99%  all infants born to that mother will be protected
The Importance of Dental Care and
Oral Hygiene
Good oral hygiene is important for maintaining
one's overall health. According to the Caucus
Educational Corporation, poor oral health has
been linked to heart and lung disease, diabetes,
stroke, low-birth weight, and premature births.
Often, diseases give their first warning signs in
the form of oral problems. The U.S. Surgeon
General also agrees that oral health is a strong
indicator of overall health and well-being (CDC,
2006).
There are four basic steps to maintain good oral
health (Colgate):
1. Brush twice daily with fluoride
toothpaste.
2. Floss every day. everyday
3. Limit the number of times you snack.
4. Visit the dentist regularly.
Some aspects of oral health are age-specific.
The following information is divided into age
groups with listed tips.
Infants:
 For mothers to be, tetracycline, a
common antibiotic, can cause tooth
discoloration for your baby and should
not be used by nursing mothers or by
expectant mothers in the last half of
pregnancy.
 Teething usually starts at around 6
months and should be brushed and
flossed daily
 Avoid baby bottle decay by not allowing
your baby to fall asleep with a bottle full
of juice or milk (try water or a pacifier)
and make sure to wipe teeth and gums
with a gentle cloth or gums after feeding
 If your water is not fluoridated, ask your
doctor about daily fluoride supplements,
because fluoride is very important even
before teeth start forming
Toddlers/Children:
 As teeth begin to grow in, this may be
very painful so gently rubbing gums with
your finger, a frozen teething ring or a
pain relief medication can help (contact
your dentist or pediatrician about
prescriptions)
 Thumb sucking is a natural reflex for
toddlers, but the habit may result in
permanent bite issues (i.e. buck teeth or
overbite) so stopping this behavior
through positive reinforcement (praise
for not sucking on thumb) or bitter
tasting medication can help
 Make sure to use a pea-size amount of
fluoride toothpaste when brushing your
child’s teeth
 Regular dental appointments should begin
being scheduled at age two
Teenagers:
 Talk to your teen about the importance
of oral hygiene
 Set a good example by practicing good
oral hygiene yourself
 Keep junk foods at a low around the
household, instead keep fresh fruits and
vegetables around for snacking
 Discourage oral piercings as they increase
risk for oral infections and can cause
injury to the entire mouth
Adults:
 Brush twice daily
 Floss once a day
 Watch for signs of gingivitis (gum
disease) such as redness, swelling or
tenderness and contact your dentist if
you experience any
 Visit the dentist twice each year for
regular check-ups
 Limit sugary foods
Albuminuria.
Definition.—The presence of albumin in the
urine.
Etiology.—The terms albuminuria and Bright's
disease were used synonymously for a number of
years, and to detect albumin in the urine was
proof sufficient for a diagnosis of nephritis.
It is now recognized, however, that there are
several conditions other than nephritis giving
rise to albuminuria, several of which are
innocent, provided they are not persistent.
The presence of albumin in the urine, in all
probability, indicates some change, however
slight and transient, in the epithelium of the
glomeruli or the capillaries of the tuft, which
permits the escape of the normal constituents,
serum-albumin and serum-globulin, from the
vessels into the renal tubules.
The principal causes giving rise to albuminuria
are acute and chronic congestion of the kidneys,
While practicing good oral hygiene is vital to
your health, there is only so much that personal
oral maintenance can do. A normal person can
easily overlook conditions that could greatly
complicate or even end one's life. Thus, visiting
your dentist for regular checkups is vital to a
healthier smile.
"Routine dental exams uncover problems that
can be easily treated in the early stages, when
damage is minimal" (American Dental Association
[ADA], 2008).
acute and chronic nephritis, the various
degenerations of the kidneys, the toxin of
scarlet fever, diphtheria, typhoid fever,
measles, influenza, and numerous infectious
diseases, certain blood changes that occur as
the result of arsenic poisoning and poisoning
from other minerals, and of certain diseases,
such as scurvy, leukemia, syphilis, and others of
like character. Pregnancy and certain lesions of
the nervous system, as epileptic seizures,
apoplexy, etc., may also be attended by
albuminuria. We may divide albuminuria, for
convenience, into functional and structural,
eliminating from the latter those cases not due
to nephritis.
Diagnosis.—The diagnosis of albuminuria is made
by finding albumin in the urine, by one of the
several tests described. The differential
diagnosis, however, will require a more careful
study. In renal or structural albuminuria, the
quantity is persistent, usually large, and contains
a larger per cent of tube-casts. There are also
symptoms of dropsy, cardiac derangement, and
more or less anemia.
In functional albuminuria, the quantity is small,
with but few casts, and is not constant.
Tests for Albumin.—The urine to be tested
should be free from any morphologic
constituents, and should therefore always be
filtered. Care should be taken that it be free
from leucorrheal and menstrual discharges. Two
samples should be taken; one before breakfast
and after a night's rest, the other at the close
of the day.
1. Boiling Test.—This is the most common, easy,
and reliable test for albumin. Fill a test-tube
about one-third full of urine: if neutral or
alkaline, add one or two drops of acetic or nitric
acid. Hold the tube slanting, that the heat may
strike the upper portion of the urine, and bring
to a boiling point. If albumin or the phosphates
be present, the upper portion becomes turbid,
which is clearly shown against the clear urine in
the bottom of the tube. Then add a few drops of
nitric acid, which will thicken the turbidity if
albumin be present, and clear it if it be absent.
Prognosis.—This depends entirely upon the cause
and length of time that albumin has been found
in the urine. Albuminuria due to fever and hemic
changes is nearly always transient, and
disappears with the subsidence of the fever.
Treatment.—The treatment is largely dietetic
and hygienic. The patient should eat sparingly of
meats and eggs, the principal diet consisting of
vegetables, fruits and milk. Exercise in the open
air, short of weariness, should be taken, and no
severe work, either mental or physical, allowed.
Drop doses of Howe's acid solution of iron, when
an acid is indicated by the red tongue, will give
favorable results.
Proteins – Heat and acetic acid method
     Principle
Proteins in urine are coagulated by heat and
the degree of coagulation isdirectly
proportional to the amount of proteins
present. Coagulation can be further
enhanced when drops of acetic acid are
added.
     Procedure
Pour 2-3 ml of urine into a 13 x 100mm glass
tube and hold it using a tube holder. Check
the urine pH; if it is >pH 7 or <3, adjust to
between 4-5 using 3% acetic acid. Heat the
upper half of the column of urine in a flame
until it boils. Look for the appearance of
cloudiness in the heated portion and
contrast it with the lower portion of the
tube. Appearance of cloudiness in the upper
portion indicates the presence of proteins.
Add 2-3 drops of 3% acetic acid to the
precipitate and observe. If the precipitate
disappears, it indicates the presence of
phosphates and carbonate (later produces
effervescence when the precipitate
disappears). Persistence of the precipitate
shows the presence of albumin. On adding 2-
3 drops of conc. HN0 3 ifthe precipitate
disappears, the presence of mucin or
nucleoprotein is suggested.
 This test is sensitive enough to detect
protein down to a concentration of 2-3 mg%.

For quality control, dilute 22g% of human

albumin solution to get a concentration of 5
mg/dl. Use this as a test and check the
reliability and sensitivity of this method.

Note: If an alkaline urine is boiled, the

protein may be converted into the so- called
"alkaline metaprotein", which is not
coagulated by heat. Therefore it is always
better to acidify the urine before doing this
test.

If too much acetic acid is added, the

protein may be converted to the so-called
 Result "acid metaprotein", which is also not
coagulated by heat. Therefore the urine
This test may be used as semi-quantitative, as should be only mildly acidic.
follows;

Colour change Result

Negative
No cloudiness
Trace
Faint cloudiness
(may be observed only if the
tube
is held against a black
background).
1+
Definite nongranular cloud
without flocculation
2+
Heavy and granular cloud
without flocculation
3+
Dense cloud with marked
flocculation
4+
Thick curdy flocculation &
coagulation

     Interpretation and quality control