Chapter 27: Postpartum Complications

Postpartum hemorrhage represents one of the most serious acute complications, defined by specific volume thresholds depending on delivery method and characterized by rapid hemodynamic changes including tachycardia, hypotension, and restlessness. The chapter explains how uterine atony, the failure of the uterine fundus to maintain adequate contraction, serves as a primary mechanism for uncontrolled bleeding and responsive to fundal massage and bladder emptying. Related hemorrhagic complications include hematoma formation, typically resulting from traumatic delivery or vascular injury, presenting with localized pain and visible tissue trauma requiring ice application and possible surgical drainage. Subinvolution, the delayed or incomplete return of uterine dimensions to prepregnancy baseline, manifests through prolonged abnormal vaginal discharge and uterine tenderness, managed through positioning, medication, and monitoring. The chapter then transitions to postpartum infections, which develop within twenty-eight days following delivery and are distinguished from normal postpartum fever through timing and symptom severity. Endometritis involves infection of the endometrial lining with characteristic foul-smelling discharge and severe uterine tenderness, treated with positioning strategies to promote drainage and intravenous antimicrobial therapy. Mastitis presents as breast inflammation with localized warmth and systemic symptoms, requiring continued breast emptying to prevent abscess formation despite discomfort. Thromboembolic complications including thrombophlebitis and pulmonary embolism represent life-threatening sequelae related to postpartum hypercoagulability, with thrombophlebitis managed conservatively through immobilization and anticoagulation while pulmonary embolism demands immediate oxygenation and emergency anticoagulant administration. The chapter concludes by acknowledging perinatal loss and the essential nursing role in supporting families through miscarriage, stillbirth, neonatal death, or adoption-related grief through culturally sensitive interventions, memory creation, and private accommodations that validate the significance of the loss experience.