Postpartum Care: Hemorrhage, Infection, and Recovery
Core concepts
Postpartum assessment focuses on the leading causes of maternal morbidity: hemorrhage, infection, thromboembolism, and hypertensive complications. Know the causes of postpartum hemorrhage (tone, trauma, tissue, thrombin) and the expected findings: fundus firm and midline, lochia patterns, and vital signs. Understand how to assess uterine tone, bladder distention, and perineal integrity.
Know the signs of postpartum infection (fever, uterine tenderness, foul lochia, wound changes) and endometritis risk after cesarean. Understand thromboembolism prevention, especially early ambulation and risk assessment. Recognize postpartum preeclampsia, which can occur after discharge, with headache, visual changes, and elevated blood pressure.
Breastfeeding support, postpartum depression screening, and discharge teaching are also tested. Know the difference between baby blues and postpartum depression, and the importance of screening tools and referral.
Traps in questions
A common trap is a boggy uterus with heavy bleeding; the answer is fundal massage and emptying the bladder, not immediate surgery. Another is confusing normal lochia progression (rubra to serosa to alba) with abnormal bleeding. Questions may describe a patient with a firm fundus but continued bleeding; consider laceration or retained tissue.
Rule of thumb
Postpartum hemorrhage: assess tone first (massage), then bladder, then look for trauma, then consider tissue and coagulopathy. Escalate if bleeding continues despite a firm fundus.
Worked example: Two hours after vaginal birth, the patient has heavy bleeding and a boggy fundus. First action: massage the fundus and assess bladder; then notify provider and prepare medications if bleeding persists.