The postpartum period is a time of major physiological transition and potential risk. Complications can arise from infection, hemorrhage, vascular events, or psychological issues, and can threaten the life or long-term health of the mother if not recognized early.
Overview of Postpartum Complications
Complications are classified by timing: early (within 24 hours) and delayed (after 24 hours to 6 weeks).
Early
- PPH
- Shock
- Urinary retention
- Trauma
Delayed
- Puerperal infection
- Thrombophlebitis
- Subinvolution
- Depression
Postpartum Hemorrhage (PPH)
Primary: ≥500 mL in 24h; Secondary: after 24h to 6 weeks.
4 Ts Mnemonic
| Cause | Description |
|---|---|
| Tone | Uterine atony (most common) |
| Tissue | Retained placenta |
| Trauma | Genital tears, hematoma |
| Thrombin | Coagulation disorders |
Puerperal Infection
Fever >38°C on 2 occasions after first 24h. Common sites: uterus, wounds, UTI.
- Risks: Prolonged labor, C-section
- Symptoms: Fever, foul lochia, pain
- Management: Broad-spectrum antibiotics
- Prevention: Asepsis, hygiene
Thromboembolic Disorders
Hypercoagulable state + immobility = DVT/PE risk.
- Symptoms: Leg pain, dyspnea
- Management: LMWH, elevation
- Prevention: Early ambulation
Subinvolution & Urinary Issues
Subinvolution: uterus fails to shrink. Urinary retention common.
Subinvolution
- Retained tissue
- Infection
- Ergometrine, curettage
Urinary
- Retention → catheter
- UTI → antibiotics
Psychological Complications
Screen all mothers before discharge.
| Condition | Timing | Management |
|---|---|---|
| Blues | 3–5 days | Reassurance |
| Depression | 2–8 weeks | Counseling, meds |
| Psychosis | Within 2 weeks | Hospitalize |
Key Takeaways
- PPH leading cause — prevent with AMTSL
- Puerperal fever + foul lochia = infection
- Early ambulation prevents DVT
- Screen for depression
- Most deaths postpartum
Conclusion
Postpartum care requires vigilance. Early detection and prompt management save lives.
Postpartum complications demand attention — the puerperium is no time for complacency.