Postpartum Care and Immediate Newborn Care
Core concepts
Postpartum care focuses on haemorrhage prevention, infection surveillance, and newborn transition. Know the normal third and fourth stages: placental delivery, uterine contraction, and lochia progression (rubra, serosa, alba). Assess uterine tone, blood loss, perineal integrity, and vital signs. Understand breastfeeding initiation within the first hour, skin-to-skin contact, and kangaroo mother care for low-birth-weight infants. Newborn immediate care includes drying, stimulation, warmth, Apgar scoring at 1 and 5 minutes, eye prophylaxis where indicated, vitamin K administration, and identification. Screen for danger signs: heavy bleeding, foul lochia, fever, perineal pain, and newborn poor feeding or lethargy.
Traps
Questions often test normal versus abnormal lochia and the timing of postpartum haemorrhage definitions (primary within 24 hours; secondary after 24 hours to 6 weeks). Another trap: assuming a boggy uterus is the only cause of bleeding - always check for retained placenta, genital tract trauma, and coagulopathy. Also watch Apgar component scoring (appearance, pulse, grimace, activity, respiration) - a common distractor is including temperature, which is not scored.
Worked rule of thumb
For any postpartum bleeding scenario, run the 4 T's: Tone (atony - most common), Tissue (retained placenta), Trauma (lacerations), Thrombin (coagulopathy). Start with uterine massage and uterotonics, then escalate.
Exam strategy
When a newborn is not breathing at birth, the answer sequence is dry, stimulate, warm, reposition, and begin positive pressure ventilation - not suction routinely.