Postpartum Care and Newborn Assessment
Postpartum Care and Newborn Assessment
This domain tests normal postpartum recovery, hemorrhage and infection, lactation support, and newborn transition. You must distinguish normal variants from emergencies and know newborn prophylaxis.
Core rules
- Postpartum hemorrhage: ACOG defines cumulative blood loss ≥1,000 mL or bleeding with signs of hypovolemia within 24 hours. Uterine atony causes most cases; massage, oxytocin, then second-line uterotonics.
- Endometritis: fever ≥38°C on at least 2 of the first 10 postpartum days, uterine tenderness, foul lochia. Treat with clindamycin plus gentamicin.
- Lactogenesis II occurs 24-72 hours postpartum; assess latch, feeding frequency, and output.
- Newborn: Apgar at 1 and 5 minutes, not a resuscitation tool. Give vitamin K IM, erythromycin ophthalmic ointment, and hepatitis B vaccine within 24 hours per policy.
- Newborn hypoglycemia thresholds are age-specific; screen at-risk infants and feed or treat per protocol.
- Jaundice: measure bilirubin and plot on an age-in-hours nomogram; phototherapy thresholds vary by risk.
Worked example
Two hours after vaginal birth, a patient has 900 mL blood loss, a boggy uterus, and tachycardia. Atony is likely. Start uterine massage and oxytocin; if bleeding continues, add tranexamic acid within 3 hours and a second uterotonic chosen by contraindications. Reasoning: quantify, treat the cause, and avoid methergine with hypertension or carboprost with asthma.
Traps
Using 500 mL as the only hemorrhage threshold; treating Apgar as resuscitation guidance; giving methergine to a preeclamptic patient; missing jaundice in a breastfeeding infant.