Postpartum complications pdf

Treatment of vaginal colonization with Candida albicans at the beginning of the pregnancy. What, on the basis of the existing medical history, should arouse suspicion of A streptococcal infection in the puerperal woman? What is a characteristic correlate in the diagnosis of Sheehan syndrome? How long does physiological postpartum uterine involution to the original size of approximately 50 g usually take?

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Published online May Susanne Schrey-Petersen , Dr. Author information Article notes Copyright and License information Disclaimer. Received Mar 21; Accepted Feb Copyright notice.

This article has been cited by other articles in PMC. Associated Data Supplementary Materials eMethods Section Search terms In particular regarding definitions and rare clinical pictures for which there is only scant primary literature, German-language standard textbooks were consulted. Breast disorders in the puerperium Common breast disorders associated with breastfeeding include: nipple soreness, milk stasis, and mastitis. Mental disorders in the puerperium The spectrum of mental disorders in the puerperium ranges from mild low mood and adjustment disorders to severe psychoses.

Abstract Background In terms of maternal morbidity and mortality, the puerperium is just as significant as pregnancy and childbirth. Results The most common and severe complications are, in the post-placental phase, bleeding and disturbances of uterine involution; in the first seven days after delivery, infection e.

Conclusion Basic familiarity with the most common and severe diseases in the puerperium is important for non-gynecologists as well, among other things because highly acute, life-threatening complications can arise that demand urgent intervention. This period is subdivided into: The immediate postnatal period the first 3 h postpartum, during which the risk of hemorrhage is high The early postnatal period the first 7 days postpartum, during which the risk of infections and maternal hypertensive disorders of pregnancy is high The late postnatal period 6—8 weeks 1.

Table 1 Potentially life-threatening diseases: symptoms and incidences. Open in a separate window. Learning objectives After reading this article, the reader should: Be able to name common and typical disorders of the puerperium and the most important characteristics of their clinical course Even as a non-gynecologist, be able to assess when and how rapidly a gynecologist or colleague in another discipline should be consulted Know the basics of treatment of these disorders.

Methods A selective literature search was performed chapter-wise covering the last 20 years in Medline and Embase, taking into consideration German- and English-language articles. Potentially life-threatening diseases. Hypertensive disorders of pregnancy The care of patients with hypertensive complications of pregnancy is also important in the puerperium and thereafter, since these indicate a generally increased cardiovascular risk.

Potentially non-life-threatening conditions. Uterine subinvolution and delayed uterine atony Hypertensive disorders of pregnancy include:. Uterine subinvolution. Delayed uterine atony. Fever, infection, and sepsis Fever and infection are common complications in the puerperium and range from mild rises in temperature for example, in the context of lactation , wound infections, urinary tract infections, and mastitis to a severe, sometimes septic course due to endomyometritis.

Postpartum endomyometritis Puerperal endometritis is an infection of the decidua that can develop following vaginal birth or cesarean section e BOX 2 Further risk factors for endomyometritis. Fever, infection, and sepsis:. Specific risk factors for uterine atony include:. Postpartum thyroiditis. Group A streptococcal sepsis. BOX 3 Treatment of infections in the puerperium. Breast disorders Common breast diseases associated with breastfeeding include: nipple soreness, breast engorgement, and mastitis.

Bladder and pelvic floor disorders Breast disorders. Incontinence and pelvic floor disorders. Thrombosis and thromboembolism Thrombosis and thromboembolism. Mental disorders in the puerperium Mental disorders in the puerperium.

Endocrine disorders Endocrine disorders in the puerperium often go undetected or are misinterpreted as postpartum depression. Endocrine disorders. Participation is possible at cme. The submission deadline is 24 June Supplementary Material eMethods Section Search terms In particular regarding definitions and rare clinical pictures for which there is only scant primary literature, German-language standard textbooks were consulted. Acknowledgments Translated from the original German by Christine Rye.

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Amir LH. These problems generally diminish within a few days. Reassurance, family support and follow-up to ensure that the patient does not develop depression are usually sufficient. Postpartum depression develops in the first weeks after childbirth; it can be severe and is often underestimated. The characteristic symptoms of depression are sadness, frequent crying, loss of self-confidence, constant concerns about the child or, on the contrary, a feeling of indifference , feeling incompetent as a mother, and feelings of guilt or even aggressive thoughts toward the child combined with insomnia and loss of appetite.

These symptoms last more than 2 weeks and gradually worsen, leading to a state of exhaustion. An understanding and reassuring attitude and help with daily activities by family and friends are essential. Antidepressant medication may be necessary choose an antidepressant compatible with breastfeeding, which should be continued whenever possible.

Refer to the Clinical guidelines , MSF. Note : postpartum depression is more frequent after a stillbirth or intrauterine foetal death. This occurs less frequently and is characterised by the onset of psychotic symptoms after childbirth. Symptoms include irritability, major mood swings, delusions, hallucinations, and disorganised, bizarre and sometimes violent behaviour.

The patient should be sent to a doctor immediately. Antipsychotic treatment, and usually hospitalisation, is necessary.