Postpartum Office Visit

Aka: Postpartum Office Visit, Postpartum Care Visit, Postpartum Period, Postpartum State, Postpartum Complication, Postpartum Care

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II. Definitions

  1. Postpartum Period
    1. First 12 weeks following delivery ("fourth trimester")

III. Epidemiology

  1. Deaths related to pregnancy occur in the Postpartum Period in 60% of cases
    1. Li (1996) Int J Gynaecol Obstet 54(1): 1-10 [PubMed]

IV. Management: Timing of Follow-up

  1. Visit 1: Early follow-up within first 3 weeks
    1. Recommended by ACOG to be within first 3 weeks (WHO recommends at 3 days and 7-14 days)
  2. Visit 2: Postpartum Visit at 6-8 weeks
    1. Standard postpartum follow-up at 6-8 weeks

V. Management: Early postpartum concerns (initial and first 2 weeks)

  1. Secondary Postpartum Hemorrhage at >24 hours after delivery (2% of women)
    1. Typically due to Retained Placenta or Endometritis
  2. Postpartum Endometritis
    1. See Maternal Fever
    2. Highest risks include Cesarean Section, Chorioamnionitis, prolonged Rupture of Membranes
    3. May present only with fever
    4. Late Endometritis occurs >7 days after delivery
  3. Lactation
    1. See Lactation Technique
    2. See Lactation Problems for the Infant
    3. See Lactation Problems for the Mother
  4. Deep Vein Thrombosis
    1. See Thromboembolic Disease in Pregnancy
    2. Relative Risk of Venous Thromboembolism in first 6 weeks postpartum is 5 fold higher than in pregnancy
      1. Venous Thromboembolism Risk does not return to baseline until 12 weeks postpartum
    3. Additional VTE Risk factors include Cesarean Section, advanced maternal age, Preeclampsia, Endometritis
    4. Consider DVT Prophylaxis with Warfarin for first 6 weeks after delivery in those with prior VTE
  5. Hypertension in Pregnancy (Preeclampsia)
    1. Pregnancy Induced Hypertension may occur up to 6 weeks after delivery (have high index of suspicion)
  6. Acute Neurologic Events
    1. Cerebral Venous Sinus Thrombosis
    2. Cerebrovascular Accident
  7. Postpartum Dyspnea
    1. See Dyspnea Causes and Acute Dyspnea
    2. Acute Pulmonary Embolism
    3. Pneumonia
    4. Pneumothorax
    5. Postpartum Anemia
    6. Amniotic Fluid Embolism
    7. Postpartum Cardiomyopathy
  8. Other concerns
    1. Postpartum Anemia
    2. Contraception (address early, esp. in the prenatal period)

VI. Management: Later postpartum concerns (after first 2 weeks)

  1. Mood Disorders and psychosocial factors
    1. Postpartum Blues
    2. Postpartum Depression
      1. Affects 10% of women in first year postpartum
      2. AAP recommends screening at the 1,2,4 and 6 month visits
    3. Postpartum Psychosocial Issues
    4. Postpartum Fatigue
  2. Postpartum Thyroiditis
    1. Affects 10% of women in first year postpartum, with either Hypothyroidism or Hyperthyroidism (including Graves)
  3. Urinary Incontinence
    1. Moderate to severe Urinary Incontinence affects up to 28% of women in the first year postpartum
    2. Pelvic Floor Exercises started prenatally reduces postpartum Urinary Incontinence
  4. Sexuality
    1. Start Contraception discussion (focusing on most reliable methods) in the prenatal period
    2. See Female Sexual Dysfunction
    3. Libido may be reduced for up to one year postpartum (related to lower Estrogen levels)
  5. Intimate Partner Violence
    1. Routine screening recommended by USPTF
    2. See HITS Screen for Intimate Partner Violence
  6. Gestational Diabetes
    1. Gestational Diabetes confers a 8-20 fold increased lifetime Diabetes Mellitus risk
    2. Consider Impaired Glucose Tolerance screening at 4-12 weeks postpartum and every 1-3 years
  7. Excessive Retained Weight
    1. Retained weight from pregnancy is 5.4 kg (11.8 lbs) over prepregnant weight at 6 months postpartum
    2. Discuss lifestyle changes (Weight Reduction, Exercise in Obesity)
  8. Constipation
    1. Increase non-caffeinated fluid per day
    2. After initial management (e.g. Fleets Enema and Magnesium Citrate), short-term Polyethylene Glycol (Miralax)
    3. Institute fiber supplementation for maintenance once Constipation improves
    4. Manage Hemorrhoids
  9. Other concerns
    1. Lactation Mastitis

VII. Complications

  1. Increased mortality
    1. Women are at the highest risk of death in the first 42 days after delivery (accounts for 45% of maternal deaths)

VIII. References

  1. Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
  2. Paladine (2019) Am Fam Physician 100(8):485-91 [PubMed]

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Related Studies

Ontology: Postpartum Period (C0086839)

Definition (OMS) Six-week period following childbirth.
Definition (NCI) The period of time immediately after labor and delivery.
Definition (CSP) occurring after childbirth or delivery, with reference to the mother; period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state; in humans generally six to eight weeks.
Definition (MSH) In females, the period that is shortly after giving birth (PARTURITION).
Concepts Temporal Concept (T079)
MSH D049590
SnomedCT 86569001, 255410009
LNC LP20597-8, LP21158-8
English postpartum, Postpartum Period, post partum, post pregnancy, postpartum period, puerperal, the period after childbirth, Postpartum state, Puerperal, Postpartum (qualifier value), Postpartum period, Postpartum state (finding), Postpartum period, NOS, Postpartum state, NOS, Period, Postpartum, Postpartum
Italian Stato postpartum, Post partum, Periodo post partum
Japanese 分娩後状態, ﾌﾞﾝﾍﾞﾝｺﾞｼﾞｮｳﾀｲ, 産じょく, 産褥期, 産床, 産褥
Swedish Postpartumperiod
Czech šestinedělí, poporodní období, Stav po porodu
Finnish Lapsivuodeaika
French Période de post-partum, Période du postpartum, Etat puerpéral, Postpartum, Post-partum, Période du post-partum, Suites de couches
Russian PUERPERAL'NYI PERIOD, POSLERODOVOI PERIOD, ПОСЛЕРОДОВОЙ ПЕРИОД, ПУЭРПЕРАЛЬНЫЙ ПЕРИОД
Croatian POSTPARTALNO RAZDOBLJE
Polish Okres poporodowy, Połóg
Hungarian Postpartum állapot
Spanish Período de Postparto, Periodo Posparto, estado posparto, estado postparto, período postparto, posparto (calificador), posparto, puerperal, Postparto
Portuguese Estado pós-parto, Período Pós-Parto
Dutch postpartumstatus, Periode, postpartum-, Postpartumperiode
German postpartaler Status, Postpartalperiode, Postpartum-Periode, Postpartum
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: postpartum complication (C0747772)

Concepts Pathologic Function (T046)
English postpartum complications, Complication;postnatal, complication postpartum, postpartum complication, complications postpartum, postnatal complication
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Postpartum care management (C1443528)

Concepts Health Care Activity (T058)
SnomedCT 409019001
English Managing Postpartum Care, Manage postpartum care, Postpartum care management (procedure), Postpartum care management
Spanish manejo de los cuidados durante el posparto (procedimiento), manejo de los cuidados durante el posparto
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Postpartum care visit (Prenatal) (C1504207)

Concepts Health Care Activity (T058)
CPT 0503F
English Postpartum care visit (Prenatal), Postpartum care visit, postpartum care visit (treatment), postpartum care visit, Postpartum care visit (prenatal), POSTPARTUM CARE VISIT
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Postpartum Disorders

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