Postpartum Inpatient Management

1. See Also
   1. Postpartum Education
   2. Cesarean Section Postoperative Management
   3. Postpartum Office Visit
2. Management: Acute
   1. Vital Signs q15 minutes for 1 hour, then q4 hours
      1. Document lochia and fundal firmness
   2. Activity
      1. Ambulate ad lib after 2 hours postpartum if stable
   3. Nursing:
      1. Inability to void
         1. Straight catheterize
         2. Record residual Urine Output
      2. Sitz baths as needed with 1:1000 Betadine prn
      3. Ice pack to perineum on and off for 6 hour postpartum
      4. Breast Pump as needed
   4. Diet: As tolerated
   5. Intravenous Access discontinuation
      1. Adequate oral intake
      2. No signs of Postpartum Hemorrhage
   6. Monitoring
      1. Hemoglobin on Postpartum Day 1
   7. Contact provider for
      1. Temperature > 100.4
      2. Systolic Blood Pressure <90 mmHg or >140 mmHg
      3. Diastolic Blood Pressure >90 mmHg or <50 mmHg
      4. Heart Rate >130 or <60
      5. Respiratory Rate >32 or <8
      6. Urine Output
         1. Foley Catheter in place: <60 cc in 2 hours
         2. Intermittent Urine collection: <300 cc per shift
3. Exam: Rounds
   1. Fever
   2. Breast Exam (if nursing)
   3. Uterus by abdominal palpation
      1. Firmness
      2. Size in relation to Umbilicus
      3. Pain on palpation (Endometritis)
   4. Lochia
      1. Expect to be bright red for 3 days
      2. Bleeding does not exceed 1-2 pads per hour
   5. Episiotomy
      1. Foul discharge or inflammation
      2. Perineal pain
4. Management: Post-delivery
   1. Pitocin (Oxytocin) starting in Third Stage of Labor
      1. Intramuscular: 10 units IM or
      2. Intramuscular: 10-20 units in 1 Liter of crystalloid
         1. Start with 300 cc bolus
         2. Maintenance with 700 cc per 8 hours
   2. Mother Rubella Not immune
      1. RubellaVaccine 0.5 cc SQ at Discharge
   3. Mother Rh Negative
      1. Blood Type and Indirect Coombs
      2. Cord blood sent to lab
      3. RhoGAM indicated for Rh Positive infant
5. Management: Symptomatic Therapy
   1. Analgesics
      1. Ibuprofen 800 mg orally three times daily as needed
      2. Tylenol 1000 mg orally every 6 hours as needed
   2. Antiemetics
      1. Ondansetron (Zofran) 4-8 mg IV/PO every 6 hours as needed
   3. Bowel regimen
      1. Osmotic Laxative (e.g. Miralax) is preferred
      2. Colace (historically used, but relatively ineffective)
         1. Dosing if used: 100 mg orally twice daily or 200 mg orally at bedtime