Postpartum problems

1. Big picture

The postpartum period, also called the puerperium, is the period after delivery during which the maternal body returns toward the non-pregnant state and adapts to breastfeeding, wound healing, contraception, and psychological changes. It is usually considered the first 6 weeks after birth, but some risks, especially thromboembolism and mental health problems, may extend beyond this period.

For the final exam, postpartum problems are best approached clinically:

Postpartum woman with a complaint
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First ask: bleeding, fever, pain, dyspnoea, headache, mood symptoms?
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Decide: haemorrhage / infection / thromboembolism / hypertensive emergency / wound or lactation problem / psychiatric emergency
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Stabilize mother first
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Investigate according to the pattern
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Treat the specific cause and prevent complications

The examiner expects you to recognize the dangerous postpartum presentations quickly:

• Heavy bleeding → postpartum haemorrhage.
• Fever + uterine tenderness + foul lochia → postpartum endometritis.
• Unilateral leg swelling or chest pain/dyspnoea → venous thromboembolism.
• Severe headache, visual symptoms, hypertension, seizures → postpartum pre-eclampsia/eclampsia.
• Breast pain + fever → mastitis or breast abscess.
• Confusion, hallucinations, suicidal or infanticidal thoughts → postpartum psychosis.

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