Postpartum Hemorrhage
PPH: blood loss >500 mL (vaginal) or >1000 mL (cesarean), OR signs of hypovolemia. Causes (4 T's): Tone (uterine atony — most common, 70%), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulopathy). Management: fundal massage, oxytocin (Pitocin), methergine, hemabate, misoprostol. Severe: uterine balloon tamponade, hysterectomy.
Postpartum Infection
Endometritis: uterine infection — fever, foul lochia, uterine tenderness. Most common post-cesarean. Treatment: broad-spectrum IV antibiotics (clindamycin + gentamicin). Wound infection: incisional erythema, drainage, fever. Mastitis: unilateral breast pain, fever, flu-like symptoms — continue breastfeeding (helps drain), antibiotics.
Postpartum Preeclampsia
Can occur up to 6 weeks postpartum. Signs: BP ≥140/90, headache, visual changes, epigastric pain. POSTPARTUM preeclampsia is often missed — women discharged before onset. Treatment: magnesium sulfate (seizure prophylaxis), antihypertensives (labetalol, hydralazine). Monitor urine output, reflexes, respiratory rate.
Postpartum Mood Disorders
Baby blues: 50–80% of women, days 3–10, self-limiting (crying, mood swings). Postpartum depression: 10–15%, persists >2 weeks, impairs function. Symptoms: depressed mood, anxiety, insomnia, inability to care for baby. Postpartum psychosis: RARE but emergency — delusions, hallucinations, risk of infanticide. Screen with Edinburgh Postnatal Depression Scale.
Important Notes
- Postpartum hemorrhage: fundal massage is FIRST intervention for uterine atony — THEN medications.
- Postpartum psychosis: psychiatric EMERGENCY — risk of suicide and infanticide. Requires immediate hospitalization.
Clinical Tips
- Postpartum preeclampsia can occur up to 6 weeks after delivery — educate patients on warning signs: severe headache, vision changes, epigastric pain.
Summary
Postpartum complications require vigilant assessment in the "fourth trimester." Early recognition of hemorrhage, infection, preeclampsia, and mood disorders prevents morbidity and mortality.
