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Postpartum Office Visit
Aka: Postpartum Office Visit, Postpartum Care Visit, Postpartum Period, Postpartum State, Postpartum Complication, Postpartum Care
- See Also
- Postpartum Inpatient Management
- Postpartum Education
- Definitions
- Postpartum Period
- First 12 weeks following delivery ("fourth trimester")
- Epidemiology
- Deaths related to pregnancy occur in the Postpartum Period in 60% of cases
- Li (1996) Int J Gynaecol Obstet 54(1): 1-10 [PubMed]
- Management: Timing of Follow-up
- Visit 1: Early follow-up within first 3 weeks
- Recommended by ACOG to be within first 3 weeks (WHO recommends at 3 days and 7-14 days)
- Visit 2: Postpartum Visit at 6-8 weeks
- Standard postpartum follow-up at 6-8 weeks
- Management: Early postpartum concerns (initial and first 2 weeks)
- Secondary Postpartum Hemorrhage at >24 hours after delivery (2% of women)
- Typically due to Retained Placenta or Endometritis
- Postpartum Endometritis
- See Maternal Fever
- Highest risks include Cesarean Section, Chorioamnionitis, prolonged Rupture of Membranes
- May present only with fever
- Late Endometritis occurs >7 days after delivery
- Lactation
- See Lactation Technique
- See Lactation Problems for the Infant
- See Lactation Problems for the Mother
- Deep Vein Thrombosis
- See Thromboembolic Disease in Pregnancy
- Relative Risk of Venous Thromboembolism in first 6 weeks postpartum is 5 fold higher than in pregnancy
- Venous Thromboembolism Risk does not return to baseline until 12 weeks postpartum
- Additional VTE Risk factors include Cesarean Section, advanced maternal age, Preeclampsia, Endometritis
- Consider DVT Prophylaxis with Warfarin for first 6 weeks after delivery in those with prior VTE
- Hypertension in Pregnancy (Preeclampsia)
- Pregnancy Induced Hypertension may occur up to 6 weeks after delivery (have high index of suspicion)
- Acute Neurologic Events
- Cerebral Venous Sinus Thrombosis
- Cerebrovascular Accident
- Postpartum Dyspnea
- See Dyspnea Causes and Acute Dyspnea
- Acute Pulmonary Embolism
- Pneumonia
- Pneumothorax
- Postpartum Anemia
- Amniotic Fluid Embolism
- Postpartum Cardiomyopathy
- Other concerns
- Postpartum Anemia
- Contraception (address early, esp. in the prenatal period)
- Management: Later postpartum concerns (after first 2 weeks)
- Mood Disorders and psychosocial factors
- Postpartum Blues
- Postpartum Depression
- Affects 10% of women in first year postpartum
- AAP recommends screening at the 1,2,4 and 6 month visits
- Postpartum Psychosocial Issues
- Postpartum Fatigue
- Postpartum Thyroiditis
- Affects 10% of women in first year postpartum, with either Hypothyroidism or Hyperthyroidism (including Graves)
- Urinary Incontinence
- Moderate to severe Urinary Incontinence affects up to 28% of women in the first year postpartum
- Pelvic Floor Exercises started prenatally reduces postpartum Urinary Incontinence
- Sexuality
- Start Contraception discussion (focusing on most reliable methods) in the prenatal period
- See Female Sexual Dysfunction
- Libido may be reduced for up to one year postpartum (related to lower Estrogen levels)
- Intimate Partner Violence
- Routine screening recommended by USPTF
- See HITS Screen for Intimate Partner Violence
- Gestational Diabetes
- Gestational Diabetes confers a 8-20 fold increased lifetime Diabetes Mellitus risk
- Consider Impaired Glucose Tolerance screening at 4-12 weeks postpartum and every 1-3 years
- Excessive Retained Weight
- Retained weight from pregnancy is 5.4 kg (11.8 lbs) over prepregnant weight at 6 months postpartum
- Discuss lifestyle changes (Weight Reduction, Exercise in Obesity)
- Constipation
- Increase non-caffeinated fluid per day
- After initial management (e.g. Fleets Enema and Magnesium Citrate), short-term Polyethylene glycol (Miralax)
- Institute fiber supplementation for maintenance once Constipation improves
- Manage Hemorrhoids
- Other concerns
- Lactation Mastitis
- Complications
- Increased mortality
- Women are at the highest risk of death in the first 42 days after delivery (accounts for 45% of maternal deaths)
- References
- Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
- Paladine (2019) Am Fam Physician 100(8):485-91 [PubMed]