Postpartum Nursing

[postpartumnurse]

Can someone tell me about clonus and DTRs after delivering a baby. I haven't been working on a post-partum unit very long, and we always check DTRs and clonus on our moms. I know it has to do with hypertension, but I don't quite understand it.

Thanks!

[ShiphrahPuah]

I am a new RN doing my orientation in postpartum, and in another week and a half, in L&D. I can tell you what I know, but hopefully if someone else knows more, they can chime in. I was worried I wasn't doing my checks for clonus correctly because I never felt anything, but then on my fourth day... whammo! Five beats on one particular patient! It's unmistakeable once you see/feel someone with clonus. This patient also had extremely brisk reflexes. We put this particular patient on seizure precautions which included putting pads on her side rails and telling her she could not walk around the room with the baby, only hold the baby if she was in bed with the rails up. (This patient was in for several more days than usual due to some psych issues). She had pregnancy-induced hypertension, so pre-eclampsia progressing to seizures was a big concern. Usually the "cure" for pre-eclampsia is delivery of the baby, but for some delivery doesn't put an end to it, and a few moms develop it AFTER delivery. To be honest, I was asking a lot of questions, but no one was as concerned as I was about the clonus, and I was not getting answers as detailed as I wanted. I looked in my OB textbook from school, and there really was minimal information which was also disappointing. I have limited information about exactly what happened since both my parents have passed away, but my own mom died from a post-delivery seizure/eclampsia/HELLP syndrome (before HELLP was identified as a syndrome), so this whole topic is of huge concern to me since I don't want to miss out on providing good care to a patient who is at risk for something serious. If you find out any more or if someone else can add to this discussion, it would be much appreciated!

[ShiphrahPuah]

One more thing. This prompted me to do some research. Check out www.preeclampsia.org for good information. The stories section will make you realize how critical it is to recognize it.

[cubbynurse]

I would say that it would be critical to have another nurse show you (and possibly multiple times) how to properly check for clonus. I just started on a high risk antepartum/postpartum unit and many of our moms have PIH/Pre-X, so we check for it often. I keep asking for a demo of it because I have yet to have a positive clonus check and keep thinking I am not doing it right.