Postpartum Care and Immediate Newborn Care
What this domain tests
Postpartum Care and Immediate Newborn Care covers the first 24 hours and first week - uterine involution, bleeding surveillance, breastfeeding establishment, maternal mental health, and the newborn's adaptation, examination and preventive package.
Core rules
- Observation. Pulse, BP, fundus, lochia and perineum at least every 15 minutes for the first hour, then per unit protocol for 24 hours, with quantified blood loss. A boggy uterus with heavy bleeding is atony until proven otherwise.
- Involution. The fundus sits at or below the umbilicus on day 1 and descends about 1 cm daily, remaining midline; afterpains are normal, especially in multiparae during feeding.
- Breastfeeding. Initiate within the first hour, keep skin-to-skin, feed on demand at least 8–12 times in 24 hours, and exclusively breastfeed for 6 months. Check positioning and attachment to prevent trauma and engorgement.
- Newborn adaptation. Apgar at 1 and 5 minutes - a score, not a resuscitation tool. Record weight, length, head circumference, temperature 36.5–37.5 °C, respiratory rate 40–60, and glucose for at-risk infants; examine for congenital anomalies.
- Prevention package in Jordan. Vitamin K 1 mg IM (0.5 mg if under 1.5 kg); birth-dose hepatitis B vaccine and BCG; heel-prick newborn screening for congenital hypothyroidism and phenylketonuria; hearing screening; eye care per unit protocol.
- Discharge teaching. Heavy bleeding, fever ≥38 °C, offensive lochia, calf pain, breast redness, poor feeding, jaundice beyond 2 weeks, and thoughts of self-harm.
Worked example
Day 2, six hours after a normal birth: the fundus is 2 cm above the umbilicus and deviated to the right, lochia moderate, pulse 96. This is a full bladder displacing the uterus, not atony. Empty the bladder, recheck fundus and bleeding in 30 minutes, and review fluids and analgesia. If the fundus stays high with heavy bleeding, escalate.
Traps that cost marks
Judging blood loss by appearance alone; treating Apgar as a diagnosis; missing a distended bladder as a cause of atony; discharging without a feeding and jaundice assessment.