Chapter 22: Nursing Management of the Postpartum Woman at Risk

The postpartum phase, while characterized by substantial physiological recovery and adaptation, presents opportunities for serious adverse events that demand vigilant assessment and prompt clinical action. Postpartum hemorrhage remains the leading cause of maternal morbidity and mortality, arising from multiple etiologies including inadequate uterine muscle contraction, incomplete expulsion of placental fragments, tears in the birth canal, and underlying bleeding disorders such as immune thrombocytopenia, von Willebrand factor deficiency, and disseminated intravascular coagulation. Nursing management of hemorrhage centers on early detection of excessive blood loss, immediate uterine fundal massage to stimulate contraction, rapid intravenous fluid administration to restore circulating volume, and timely medication administration including oxytocin and misoprostol to enhance myometrial tone. Venous thromboembolic complications, encompassing deep vein thrombosis and life-threatening pulmonary embolism, develop as consequences of blood stasis in the lower extremities and the hypercoagulable state inherent to pregnancy and postpartum recovery. Prevention requires early ambulation, sequential compression devices, and anticoagulation therapy in high-risk patients. Postpartum infection manifests through multiple pathways including endometrial inflammation, abdominal wound contamination, urinary system involvement, and breast tissue infection, typically involving multiple bacterial organisms and managed through broad-spectrum antibiotic therapy, wound assessment using standardized scales such as REEDA scoring, and supportive measures. Finally, the chapter emphasizes postpartum mood and anxiety disorders, ranging from transient emotional adjustment to severe postpartum depression and postpartum psychosis, which require systematic maternal mental health screening using validated instruments such as the Edinburgh Postnatal Depression Scale to enable early recognition and timely psychopharmacological or psychological intervention, preventing progression and supporting maternal-infant bonding and family stability.