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Chapter 28 - The Immediate Puerperium

Published online by Cambridge University Press:  16 October 2025

By
Zohaib Arain  and
Shankari Arulkumaran
Edited by
Sir Sabaratnam Arulkumaran
Sir Sabaratnam Arulkumaran
Affiliation:
St George's Hospital Medical School, University of London
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Summary

This chapter discusses care considerations for the immediate puerperium. This includes an overview of routine postnatal care for the mother’s physical and mental health, as well as important signs and symptoms of maternal and infant compromise. Common puerperal complications are described and risk factors, as well as management reviewed. Presentation and management of postnatal emergencies such as postpartum haemorrhage and haematomas, sepsis, venous thromboembolism and pulmonary embolus are discussed. Chronic postnatal complications including hypertension, problems of the lower urinary tract and pelvic organs, anaesthetic complications, wound breakdown, breast pain and anaemia are detailed, with a final section dedicated to mental health and the care of a woman presenting with a stillbirth.

Keywords

puerperiuminfant carepostpartum haemorrhagesepsisvenous thromboembolismpostnatal hypertensionpelvic dysfunctionbreast caremental healthstillbirth

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Chapter
Information
Best Practice in Labour and Delivery , pp. 357 - 367
Publisher: Cambridge University Press
Print publication year: 2025

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References

National Collaborating Centre for Primary Care (UK). Postnatal care: routine postnatal care of women and their babies. London: Royal College of General Practitioners (UK); 2006.Google Scholar
MacArthur, C, Lewis, M, Knox, EG. Comparison of long-term health problems following childbirth among Asian and Caucasian mothers. Br J Gen Pract. 1993;43(377):519–22.Google Scholar
Glazener, CM, Abdalla, M, Stroud, P, Naji, S, Templeton, A, Russell, IT. Postnatal maternal morbidity: extent, causes, prevention and treatment. Br J Obstet Gynaecol. 1995;102(4):282–7.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Postnatal care (NICE Guideline NG194). 2021 20 Apr [cited 2024 14 Mar]. Available from: www.nice.org.uk/guidance/ng194Google Scholar
Knight, M, Kenyon, S, Brocklehurst, P, et al., editors, on behalf of MBRRACE-UK. Saving lives, improving mothers’ care: lessons learned to inform future maternity care from the UK and Ireland – confidential enquiries into maternal deaths and morbidity 2009–12 (Core report). 2014 Dec [cited 2024 14 Mar]. Available from: https://tinyurl.com/2xk8murrGoogle Scholar
MBRRACE-UK. Saving lives, improving mothers’ care: state of the nation surveillance report – surveillance findings from the UK Confidential Enquiries into Maternal Deaths 2019–21. 2023 Oct [cited 2024 14 Mar]. Available from: https://tinyurl.com/36uhn2veGoogle Scholar
Department of Health and Social Care. UK Chief Medical Officers’ physical activity guidelines. 2019 7 Sep [cited 2024 14 Mar]. Available from: https://tinyurl.com/y4ym5krzGoogle Scholar
Group BMJP. Covid-19 and pregnancy. BMJ. 2020; 369: m1672.CrossRefGoogle Scholar
Prevention and management of postpartum haemorrhage: Green-top Guideline No. 52. BJOG. 2017; 124(5):e106–49.CrossRefGoogle Scholar
Morgans, D, Chan, N, Clark, CA. Vulval perineal haematomas in the immediate postpartum period and their management. Aust N Z J Obstet Gynaecol. 1999;39(2):223–7.CrossRefGoogle ScholarPubMed
The UK Sepsis Trust. The sepsis manual. 6th ed. 2024. [cited 2025 27 Mar]. Available from: https://tinyurl.com/wap4wrb3Google Scholar
, H E, Vk, S, Kola, SK, Kg, DK. Spontaneous caecal perforation associated with Ogilvie’s syndrome following vaginal delivery – a case report. J Clin Diagn Res. 2014;8(6):ND08–9.Google Scholar
Jayaram, P, Mohan, M, Lindow, S, Konje, J. Postpartum acute colonic pseudo-obstruction (Ogilvie’s syndrome): a systematic review of case reports and case series. Eur J Obstet Gynecol Reprod Biol. 2017;214:145–9.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians & Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium (Green-top Guideline No. 37a). 2015 Apr [cited 2024 29 Mar]. Available from: www.rcog.org.uk/media/m4mbpjwi/gtg-no37a-2015_amended-2023.pdfGoogle Scholar
Azarisman, SMS, Liza, RA, Radhiana, H, et al. Immediate postpartum cardiorespiratory collapse: a management quandary. Blood Coagul Fibrinolysis. 2010;21:601–4.CrossRefGoogle ScholarPubMed
Magee, L, von Dadelszen, P. Prevention and treatment of postpartum hypertension. Cochrane Database Syst Rev. 2013;4:CD004351.Google Scholar
National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management (NICE Guideline NG133). 2019 25 Jun [cited 2024 14 Mar]. Available from: www.nice.org.uk/guidance/ng133Google Scholar
Maronge, L, Bogod, D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73 Suppl 1:61–6.CrossRefGoogle ScholarPubMed
Wuytack, F, Begley, C, Daly, D. Risk factors for pregnancy-related pelvic girdle pain: a scoping review. BMC Pregnancy Childbirth. 2020;20(1):739.CrossRefGoogle ScholarPubMed
Wiezer, M, Hage-Fransen, MAH, Otto, A, et al. Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2020;48:102154.CrossRefGoogle ScholarPubMed
Elden, H, Gutke, A, Kjellby-Wendt, G, Fagevik-Olsen, M, Ostgaard, H-C. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord. 2016;17:276.CrossRefGoogle Scholar
Bjelland, EK, Stuge, B, Vangen, S, Stray-Pedersen, B, Eberhard-Gran, M. Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum. Am J Obstet Gynecol. 2013;208(4):298.e1–7.CrossRefGoogle Scholar
Jain, S, Eedarapalli, P, Jamjute, P, Sawdy, R. Symphysis pubis dysfunction: a practical approach to management. Obstet Gynaecol. 2006;8(3):153–8.CrossRefGoogle Scholar
McCormick, T, Ashe, RG, Kearney, PM. Urinary tract infection in pregnancy. Obstet Gynaecol. 2008;10:156–62.CrossRefGoogle Scholar
Karim, F, Araklitis, G, Robinson, D, Cardozo, L. The management of urogynaecological problems in pregnancy and the postpartum period. Obstet Gynaecol. 2022;24(3):167–75.CrossRefGoogle Scholar
Ferrari, A, Mannella, P, Caputo, A, Simoncini, T, Bonciani, M. Risk and protective factors for pregnancy-related urinary incontinence until 1 year postpartum: a cohort study using patient-reported outcome measures in Italy. Int J Gynecol Obstet. 2024;164(1):200–9.CrossRefGoogle ScholarPubMed
Moossdorff-Steinhauser, HFA, Berghmans, BCM, Spaanderman, MEA, Bols, EMJ. Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior. Int Urogynecol J. 2021;32(7):695–701.CrossRefGoogle ScholarPubMed
Asali, F, Mahfouz, I, Phillips, C. The management of urogynaecological problems in pregnancy and the early postpartum period. Obstet Gynaecol. 2012;14(3):153–8.CrossRefGoogle Scholar
El Shamy, T, Sein, E, Sharma, S, Domoney, C. Postpartum perineal wound dehiscence. Obstet Gynaecol. 2023;25(2):146–52.CrossRefGoogle Scholar
Williams, MK, Chames, MC. Risk factors for the breakdown of perineal laceration repair after vaginal delivery. Am J Obstet Gynecol. 2006;195(3):755–9.CrossRefGoogle ScholarPubMed
Schoenfeld, EM, McKay, MP. Mastitis and methicillin-resistant Staphylococcus aureus (MRSA): the calm before the storm? J Emerg Med. 2010;38(4):e31–34.CrossRefGoogle ScholarPubMed
Amir, LH, Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #4: mastitis, revised March 2014. Breastfeed Med. 2014;9(5):239–43.CrossRefGoogle Scholar
Perelló, MF, Coloma, JL, Masoller, N, Esteve, J, Palacio, M. Intravenous ferrous sucrose versus placebo in addition to oral iron therapy for the treatment of severe postpartum anaemia: a randomised controlled trial. BJOG. 2014;121(6):706–13.CrossRefGoogle ScholarPubMed
Sultan, P, Bampoe, S, Shah, R, et al. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(1):19–29.e3.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (Clinical Guideline CG192). 2014 17 Dec [cited 2024 5 Feb]. Available from: https://tinyurl.com/yc54xhx6Google Scholar
Office for National Statistics. Births in England and Wales: 2022 (refreshed populations). 2024 23 Feb [cited 2024 14 Mar]. Available from: https://tinyurl.com/mrykjtr9Google Scholar
Smith, GCS, Fretts, RC. Stillbirth. Lancet. 2007;370(9600):1715–25.CrossRefGoogle ScholarPubMed
Goldenberg, RL, McClure, EM, Bhutta, ZA, et al. Stillbirths: the vision for 2020. Lancet. 2011;377(9779):1798–805.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians & Gynaecologists. Care of late intrauterine fetal death and stillbirth (Green-top Guideline No. 55). 2024 28 Oct [cited 2025 27 Mar]. Available from: https://tinyurl.com/2cpcjj5tGoogle Scholar

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