Postpartum Care and Immediate Newborn Care
This domain tests the first two hours after birth, when most maternal deaths from bleeding occur, and the first minutes of newborn adaptation.
Core rules
- Monitor mother every 15 minutes for 2 hours: pulse, BP, uterine tone, lochia, bladder and perineum.
- Inspect the placenta for completeness; if cotyledons or membranes are missing, refer for manual removal or evacuation.
- Newborn: dry, stimulate, assess breathing and tone, keep skin-to-skin, delay cord clamping 1–3 minutes if not needing resuscitation, give vitamin K 1 mg IM, eye prophylaxis per national policy, and initiate breastfeeding within one hour.
- Keep the cord clean and dry; apply chlorhexidine where supplied by national guidance.
- Schedule postpartum contacts within 24 hours, at day 3, day 7–14 and week 6.
Worked example
Thirty minutes after a normal birth the uterus is boggy, blood loss is 400 mL, pulse 110 and BP 100/60. Reasoning: uterine atony is the likely cause. Massage the uterus, empty the bladder, give oxytocin 10 IU IM if not already given, start IV fluids and monitor. If bleeding continues, add tranexamic acid and misoprostol and refer. Do not wait for the placenta to be 'complete' before treating shock.
Traps
- Estimating blood loss by eye alone.
- Missing a retained placenta because the cord is cut short.
- Delaying newborn drying to complete the mother's chart.
- Sending a bleeding woman without IV access or a companion.