The postpartum period is typically defined as the first 6–12 weeks following delivery of an infant. During this time, postpartum complications can occur either as a result of the normal physiologic changes the body undergoes to return to its prepregnancy state or as complications of the labor and delivery process. These changes include those in the reproductive, urinary, cardiovascular, GI, and endocrine systems. In addition, postpartum hemorrhage Postpartum hemorrhage Postpartum hemorrhage is one of the most common and deadly obstetric complications. Since 2017, postpartum hemorrhage has been defined as blood loss greater than 1,000 mL for both cesarean and vaginal deliveries, or excessive blood loss with signs of hemodynamic instability. Postpartum Hemorrhage, postpartum fever Postpartum fever Postpartum fever is a common and often preventable complication that occurs within the 1st 10 postpartum days. The most common etiology is an infection of the uterine lining known as endometritis. Other common etiologies include surgical or perineal wound infections and mastitis. Postpartum Fever, and psychiatric disorders are common complications during this time frame. Because of the complexity and clinical importance of these topics, they are each discussed in separate concept articles.
Last updated: Feb 21, 2023
The postpartum period is typically defined as the period of time following an obstetric delivery:
During the postpartum period, the mother’s body physically returns to its prepregnant state. There are a number of potential complications that can occur during this time, some of which can cause significant morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status and mortality Mortality All deaths reported in a given population. Measures of Health Status. Some of the most important include:
Three of the most important complications are postpartum hemorrhage Postpartum hemorrhage Postpartum hemorrhage is one of the most common and deadly obstetric complications. Since 2017, postpartum hemorrhage has been defined as blood loss greater than 1,000 mL for both cesarean and vaginal deliveries, or excessive blood loss with signs of hemodynamic instability. Postpartum Hemorrhage, postpartum fever Postpartum fever Postpartum fever is a common and often preventable complication that occurs within the 1st 10 postpartum days. The most common etiology is an infection of the uterine lining known as endometritis. Other common etiologies include surgical or perineal wound infections and mastitis. Postpartum Fever, and postpartum psychiatric disorders Postpartum Psychiatric Disorders The postpartum (PP) period is a common time for the emergence or exacerbation of psychiatric disorders. Postpartum blues, PP depression, and PP psychosis are 3 of the most common psychiatric disorders experienced in the PP period. Although both genders are affected, PP is more common in women. Postpartum Psychiatric Disorders; each of these is discussed in full detail on their own pages, but highlights are briefly summarized below.
Postpartum hemorrhage Postpartum hemorrhage Postpartum hemorrhage is one of the most common and deadly obstetric complications. Since 2017, postpartum hemorrhage has been defined as blood loss greater than 1,000 mL for both cesarean and vaginal deliveries, or excessive blood loss with signs of hemodynamic instability. Postpartum Hemorrhage:
Postpartum fever Postpartum fever Postpartum fever is a common and often preventable complication that occurs within the 1st 10 postpartum days. The most common etiology is an infection of the uterine lining known as endometritis. Other common etiologies include surgical or perineal wound infections and mastitis. Postpartum Fever:
Postpartum psychiatric disorders Postpartum Psychiatric Disorders The postpartum (PP) period is a common time for the emergence or exacerbation of psychiatric disorders. Postpartum blues, PP depression, and PP psychosis are 3 of the most common psychiatric disorders experienced in the PP period. Although both genders are affected, PP is more common in women. Postpartum Psychiatric Disorders:
PP blues PP blues Mild depressive symptoms that are transient and self-limiting in the perinatal period Postpartum Psychiatric Disorders | PP depression PP depression Depression in postpartum women, usually within four weeks after giving birth (parturition). The degree of depression ranges from mild transient depression to neurotic or psychotic depressive disorders. Postpartum Psychiatric Disorders | PP psychosis PP psychosis A psychiatric manifestation with abrupt onset after delivery that is characterized by psychotic symptoms.Symptoms are similar to those of non-obstetric psychosis. The presenting symptoms are often severe, interfere with daily activities, and require hospitalization. Postpartum Psychiatric Disorders | |
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Epidemiology | 50%–80% of pregnancies | 10%–25% of pregnancies | < 1% of pregnancies |
Common symptoms | Guilt, crying, feeling of being overwhelmed | Inability to cope, disinterest in self, disinterest in infant | Visual or auditory hallucinations Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with mental disorders. Schizophrenia |
Onset | Birth to 2 weeks PP | 2 weeks to 1 year after delivery | Days to 1 year after delivery |
Treatment | Resolves spontaneously | Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy, antidepressants | Antipsychotics |
Differential diagnoses |
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DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis and PE are important causes of peripartum morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status and mortality Mortality All deaths reported in a given population. Measures of Health Status. Additionally, amniotic fluid Amniotic fluid A clear, yellowish liquid that envelopes the fetus inside the sac of amnion. In the first trimester, it is likely a transudate of maternal or fetal plasma. In the second trimester, amniotic fluid derives primarily from fetal lung and kidney. Cells or substances in this fluid can be removed for prenatal diagnostic tests (amniocentesis). Placenta, Umbilical Cord, and Amniotic Cavity embolism ( AFE AFE Blocking of maternal circulation by amniotic fluid that is forced into uterine veins by strong uterine contraction near the end of pregnancy. It is characterized by the sudden onset of severe respiratory distress and hypotension that can lead to maternal death. Complications during Childbirth) may present similarly to PE.
Both constipation Constipation Constipation is common and may be due to a variety of causes. Constipation is generally defined as bowel movement frequency < 3 times per week. Patients who are constipated often strain to pass hard stools. The condition is classified as primary (also known as idiopathic or functional constipation) or secondary, and as acute or chronic. Constipation and hemorrhoids Hemorrhoids Hemorrhoids are normal vascular cushions in the anal canal composed of dilated vascular tissue, smooth muscle, and connective tissue. They do not cause issues unless they are enlarged, inflamed, thrombosed, or prolapsed. Patients often present with rectal bleeding of bright red blood, or they may have pain, perianal pruritus, or a palpable mass. Hemorrhoids are extremely common in the immediate postpartum period.
Formerly known as Clostridium difficile Clostridium difficile A common inhabitant of the colon flora in human infants and sometimes in adults. The type species clostridioides difficile is formerly known as Clostridium difficile. It is a causative agent for clostridioides infections and is associated with pseudomembranous enterocolitis in patients receiving antibiotic therapy. Clostridia:
Affected nerve | Mechanism of injury | Symptoms |
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Femoral nerve Femoral Nerve A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints. Femoral Region and Hernias: Anatomy | Prolonged pushing with extreme hip flexion Flexion Examination of the Upper Limbs |
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Lateral femoral cutaneous nerve | Prolonged pushing with extreme hip flexion Flexion Examination of the Upper Limbs |
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Peroneal nerve Peroneal nerve The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. Popliteal Fossa: Anatomy |
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Foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy drop |
Obturator nerve Obturator Nerve A nerve originating in the lumbar spinal cord (L2 to L4) and traveling through the lumbar plexus to the lower extremity. The obturator nerve provides motor innervation to the adductor muscles of the thigh and cutaneous sensory innervation of the inner thigh. Thigh: Anatomy |
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Giving patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship appropriate anticipatory guidance about what to expect when they go home postpartum is critically important to help patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship identify serious complications early while avoiding unnecessary medical visits for normal processes.
Important topics to address include:
Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship should be instructed to seek medical attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment for:
Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship should typically be advised to: