Chapter 25: Postpartum Complications & Nursing Care

Postpartum Complications & Nursing Care academic chapter provides an essential guide to nursing care when deviations from the typical postpartum period occur, underscoring the necessity of comprehensive, early intervention, often guided by the six Quality and Safety Education for Nurses (QSEN) competencies. The most serious physiologic concern discussed is postpartum hemorrhage (PPH), defined as blood loss of 1,000 mL or more, which is a leading cause of maternal mortality. PPH etiology is summarized by the "four Ts": Tone (uterine atony, the primary cause, managed initially by fundal massage and uterotonics such as oxytocin or methylergonovine), Trauma (including cervical, vaginal, and perineal lacerations), Tissue (retained placental fragments, which require intervention like dilation and curettage or D&C), and Thrombin (coagulation disorders like disseminated intravascular coagulation or DIC). Assessment techniques for hemorrhage include monitoring subtle changes in vital signs, inspecting lochia, and accurately measuring blood loss (1 gram of weight on a perineal pad equals 1 mL of blood volume). Puerperal infections, typically marked by a temperature greater than 100.4 degrees Fahrenheit after the first 24 hours postpartum, are detailed, covering localized infections like mastitis (breast infection treatable with antibiotics while encouraging continued milk expression) and systemic infections such as endometritis (infection of the uterine lining) and the life-threatening peritonitis. The risk of thrombophlebitis, involving blood clot formation (deep vein thrombosis or DVT), is heightened during the puerperium, necessitating vigilance; management involves anticoagulation therapy and avoiding leg massage to prevent a fatal pulmonary embolus (PE). Non-hemorrhagic complications also covered include subinvolution (incomplete return of the uterus to pre-pregnancy size), vulvar hematomas, urinary retention (often requiring catheterization if post-void residual is greater than 100 mL), and postpartum preeclampsia. Lastly, the chapter addresses emotional complications, distinguishing between the common, transient postpartum blues, severe postpartum depression (PPD, requiring formal screening using tools like the Edinburgh Postnatal Depression Scale or EPDS), and the rare but dangerous postpartum psychosis (PPP), which involves a loss of reality and poses a high safety risk to the patient and newborn. Throughout the care process, nurses must integrate knowledge to support patient-infant bonding and address the financial, social, and emotional disruption these complications impose on the entire family.