Recommend lifestyle changes and annual follow-up for blood pressure and body weight monitoring Hospitalize if signs of end organ damage or blood pressure ≥ 160/110 mm Hg Treat if blood pressure ≥ 150/100 mm Hg, can use oral nifedipine or labetalol Recommend office visit to check blood pressure within 7 days of delivery Highest risk is < 48 hours after delivery Risk is five times higher during postpartum period than pregnancyĮlevated risk persists up to 12 weeks postpartumĪvoid direct thrombin inhibitors and direct oral anticoagulants in women who are breastfeeding Higher likelihood of anaerobic infection or chlamydia in late infections Usually requires intravenous antibiotics, most evidence for clindamycin and gentamicin cesarean) delivery, and maternal age of 35 years or olderįever with no other source, may be accompanied by uterine tenderness and vaginal discharge Risk factors include immediate postpartum hemorrhage, vaginal (vs. Hemorrhage can occur up to 12 weeks postpartum Occurs in up to 2% of women in the postpartum period Ultrasonography to look for retained placental fragmentsĪntibiotics for endometritis if infection is suspected Women at high risk of perinatal depression should receive preventive counseling in the postpartum period. Longitudinal cohort studies and expert consensusĪll women should be screened in the postpartum period for depression in settings where systems are in place to ensure diagnosis, treatment, and follow-up. Women with gestational diabetes mellitus should be screened for diabetes with a 75-g two-hour fasting oral glucose tolerance test at four to 12 weeks postpartum. Women with hypertensive disorders should have a blood pressure check within seven days postpartum. 3, 9Īmerican College of Obstetricians and Gynecologists and World Health Organization expert consensus A comprehensive visit should occur within 12 weeks postpartum and include a biopsychosocial assessment. Initial follow-up should be within three weeks after delivery, in person or by phone. Treating these issues during the postpartum period is important to the new mother's immediate and long-term health. Additional patient concerns may include urinary incontinence, constipation, breastfeeding, sexuality, and contraception. All women should have a biopsychosocial assessment (e.g., depression, intimate partner violence) screening in the postpartum period, and preventive counseling should be offered to women at high risk. Patients with hypertensive disorders of pregnancy should have a blood pressure check performed within seven days of delivery. Women diagnosed with gestational diabetes should receive a 75-g two-hour fasting oral glucose tolerance test between four and 12 weeks postpartum. Complications of pregnancy, such as hypertensive disorders and gestational diabetes mellitus, affect a woman's long-term health and require specific attention. Care should initially focus on acute needs and risks for morbidity and mortality and then transition to care for chronic conditions and health maintenance. A full assessment is recommended within 12 weeks. Outpatient postpartum care should be initiated within three weeks after delivery in person or by phone, and may require multiple contacts with the patient to fully address needs and concerns. The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester.
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