Pocket ObGyn – Routine Postpartum Care

Pocket ObGyn – Routine Postpartum Care
See Abbreviations

Monitoring: Frequent VS (q15mins ´ 2 h; q shift [8–12 h] thereafter); assess uterine size & tone, perineal integrity, abdominal incisions; note quantity of vaginal bleeding; high vigilance for intra-abdominal or pelvic hemorrhage & urinary retention
Pain: NSAIDs & cold compresses to the perineum, w/ opioids reserved for breakthrough or postsurgical pain (Cochrane Database Syst Rev 2011;(5):CD004908)
Constip: Stool softeners & laxatives as needed & w/ opioids; longer stool softener rx for 3rd/4th-degree laceration repairs

Urinary retention: Mobilize early to facilitate voiding; use intermittent or indwelling catheter if unsuccessful
Malodorous lochia/discharge: Inspect perineum for wound breakdown or retained sponge
HA: Most likely are tension, but consider preeclampsia & postdural puncture HA (Am J Obstet Gynecol 2007;196:318). See Chap
Fever: W/u source, considering UTI, wound infxn, mastitis/breast abscess; breast engorgement; endometritis; septic pelvic thrombophlebitis; clostridium-difficile infxn; drug or anesthesia rxn
Discharge w/i 24–48 h after Uncomp vaginal deliv & 48–96 h after routine cesarean deliv

Postpartum visit recommended for all women at 4–6 w postpartum & 7–14 d postcesarean or complicated vaginal deliv (eg, sev laceration)
Hx should assess: Mat–infant bonding, including feeding; breast complaints; mat mood/ coping & social supports; urinary & fecal continence; resumption of intercourse & contraceptive plan; consider thyroid dysfxn (hyper& hypo-) (Thyroid 2006;16:573)
Exam should include: VS (including weight & BP); breasts, abd, & pelvis

Mean resumption of ovulation in nonlactating women occurs 45–94 d (25 d at earliest) postpartum (Obstet Gynecol 2011;117(3):657)
Exclusive breastfeeding is 98% effective as contraception in the 1st 6 mo postpartum if amenorrheic (Contraception 1989;39:477)
Sterilization (by tubal ligation) may be performed immediately (w/i ~24 h) postpartum or as an interval procedure (after 6 w)
Barrier methods may be used on resumption of intercourse
Progest-only methods safe to initiate postpartum in any woman w/o a contraindication, & do not influence breast milk production (Contraception 2010;82:17)
IUD (copper or levonorgestrel) may be placed either immediately postpartum (w/i

10 min of deliv of placenta) or 6–8 w postpartum

Estrogen-containing contraceptives may be initiated 21 d postpartum in women w/o additional risk factors forVTE, & otherwise may be considered at 6 w CDC & ACOG recommend 4–6-w delay before starting estrogen-containing contraceptives in breastfeeding women depending on VTE risk profile (MMWR Morb Mortal Wkly Rep 2011;60:878; Obstet Gynecol 2006;107:1453). Estrogen may suppress breast milk production.