Postpartum psychosis — hallucinations, delusions, thoughts of harming the baby.
A psychiatric emergency. The infant must not be left alone with her.
🖼️ Feeding the newborn.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ High-yield — what the exam actually asks
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The greatest hemorrhage risk is the first 1–2 hours after birth.
Boggy uterus DEVIATED to the right + a pad saturated in 10 minutes = bladder distension → have her void first. Fix the cause by the least invasive route before uterotonics. Methylergonovine IM only if bleeding continues after the bladder is empty; bimanual compression is a provider-level last resort.
Boggy fundus above the umbilicus at 2 hours → massage the fundus and assess the bladder. Teaching, capping the newborn and feeding math all wait.
FIRM fundus with a heavily saturated pad = the uterus is not the source. Inspect perineum, vagina and cervix for a laceration or hematoma — look for bright red continuous trickling without clots. Massage will not help.
Severe perineal pain 30 minutes after birth → assess for a hematoma BEFORE analgesia or ice. Assess before you intervene; circulation before comfort.
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Perineal comfort timing: ice for the first 24 hours, then a warm sitz bath 15–20 minutes. At 36 hours the answer is the sitz bath.
Involution: the fundus descends ~1 cm/day. At 24 hours it should be about 1 cm below the umbilicus, and midline.
Lochia: rubra dark red days 1–3, serosa pinkish-brown days 4–10, alba yellow-white day 10 to about 6 weeks.
Postpartum hemorrhage = >500 mL vaginal or >1,000 mL cesarean. Weigh saturated items — 1 g = 1 mL.
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Postpartum blues resolve by about 2 weeks. Persistent sadness, fatigue and inability to care for the newborn at2 weeks = postpartum depression → discuss support and refer. Nurses refer, they do not diagnose, and never advise stopping breastfeeding for mood.
Mastitis is unilateral: hard tender localized mass, redness, chills, fever. Keep emptying the breast and give antibiotics.
Expect postpartum diuresis and diaphoresis. A pulse in the 50s–60s is normal postpartum bradycardia.
Calc — oxytocin for PPH: 20 units/1,000 mL at 60 mL/hr → 60 × 20 ÷ 1,000 = 1.2 units/hr.
📕 From your ATI review book
Covered by ch. 17 & 20 · ch. 19, 21.
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BUBBLE-E: breasts, uterus, bowel, bladder, lochia, episiotomy/ecchymosis — plus vitals and pain.
The fundus RISES to the umbilicus at 1 hour, then descends ~1 cm/day; halfway to the symphysis by day 6; not palpable after ~2 weeks. Uterine weight falls from ~1,000 g to 100 g by 6 weeks.
NEVER express clots until the uterus is firmly contracted — pushing on an uncontracted uterus can invert it.
Lochia by pad staining: scant <2.5 cm · light 2.5–10 · moderate >10 · heavy = one pad saturated in an hour. One pad in 15 minutes, or pooling under the buttocks, is excessive.
Lochia going BACKWARD in color, or rubra past day 3, suggests retained fragments. A steady bright red trickle with a firm fundus is a laceration.
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PPH = cumulative loss of 1,000 mL or more, OR any loss with signs of hypovolemia, within 24 h of any birth type. Quantify it — weigh pads and clots, subtract irrigation.
Earliest hemorrhage indicator is a rising pulse with a falling blood pressure. Skin changes and altered LOC come later.
Uterotonic catches: oxytocin → hypotension and water intoxication · methylergonovine contraindicated in hypertension · carboprost → fever, nausea, diarrhea, avoid in asthma · tranexamic acid within 3 h of birth.
Expected postpartum oddities that are NOT emergencies: WBC 20,000–25,000 (can reach 30,000) · heart rate as low as 50/min · temp up to 38°C in the first 24 h · diuresis over 3,000 mL/day · diaphoresis. Tachycardia and fever AFTER 24 hours are not normal.
Voiding under 150 mL repeatedly = retention with overflow. Assist to void within 6 h.
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DVT: elevate, warm moist compresses, measure circumference — NEVER massage. Protamine reverses heparin, phytonadione reverses warfarin. Warfarin is teratogenic and OCs are contraindicated with it.
Mastitis: keep breastfeeding or pumping on the affected side — emptying is the treatment.
Maternal role phases: taking-in (first 24–48 h, dependent, replays the birth) → taking-hold (day 2–3, ready to learn, when blues appear) → letting-go.
Blues affect up to 85% and clear within 2 weeks. PPD hits ~1 in 8 within 12 months and does NOT self-resolve. Psychosis appears within the first 2 weeks with hallucinations and delusions, and bipolar disorder is the leading risk factor. In psychosis the priority is asking directly about thoughts of harming herself or the newborn.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 17 (postpartal family) · ch. 25 (postpartum complications).
The fundus descends about one fingerbreadth (1 cm) a day and is no longer palpable abdominally by roughly day 10.
Filling versus engorgement: milk forms on day 3 to 4 and the breasts feel full and firm — that is filling. Once it is warm and uncomfortable, it is engorgement. Mastitis is infection: pain, swelling, redness, and it needs antibiotics.
Pillitteri defines postpartum hemorrhage as more than 1,000 mL in 24 hours. Older sources still use 500 mL vaginal / 1,000 mL cesarean — if your exam uses the older numbers, answer with the course. Either way the commonest cause is uterine atony.
A temperature over 100.4°F after the first 24 hours is puerperal infection. Within the first 24 hours, a mild rise is often dehydration.
Thrombophlebitis usually extends from an endometrial infection — the two travel together.
Postpartum blues are normal; depression and psychosis are not. Psychosis involves an actual break from reality and is an emergency.
⚠️ Exam traps
Three findings, three different answers. Boggy + displaced → bladder. Boggy + midline → atony, massage. Firm + bleeding → laceration.
Ice for 24 hours, heat after. Reversing them is a standing distractor.
🧠 Mind maps 3
One per disorder, built from the structure of your ATI chapter.
Complications of the Postpartum Period
🎯 Who gets it
DVT/PE: cesarean birth, immobility, obesity, smoking, preeclampsia, age over 40, prior thromboembolism.
DIC triggers, commonest first: abruptio placentae, then amniotic fluid embolism, fetal demise, severe preeclampsia/HELLP, sepsis.
📋 Postpartum Physiological Adaptations and Nursing Care6 parts
ATI Active Learning Template — System DisorderPostpartum Physiological Adaptations and Nursing Care
Filled from ATI chapter 17, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 7 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers physical recovery after birth -- uterine involution, lochia, breast changes, cardiovascular and GI/GU shifts, and vital sign norms -- plus the BUBBLE assessment, hemorrhage prevention, and comfort care during the fourth stage of labor.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Empty the bladder before every fundal assessment — a full bladder displaces the uterus and mimics atony.
Early ambulation reduces VTE risk and speeds bowel recovery.
Rho(D) within 72 hours, and MMR before discharge if non-immune.
Screen for depression before discharge and at follow-up — not only at the six-week visit.
Discuss contraception before discharge; ovulation can precede the first period.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2023.
Prior postpartum hemorrhage raises recurrence risk in a later birth to about 15%
Uterine overdistention from twins, excess amniotic fluid, or a large infant predisposes to poor contraction after birth
Prolonged oxytocin use during labor or magnesium sulfate administration can leave the uterus less responsive afterward
Class III obesity, defined as a BMI over 40, is an independent risk factor for atony
💬 Around the patientClient Education · Interprofessional Care
Client Education
Change perineal pads often and wash hands before and after care to cut infection risk.
Avoid tampons postpartum; they raise infection risk.
Use a squeeze bottle for perineal cleansing; blot front to back after toileting.
Give rubella vaccine subcutaneously if nonimmune; avoid pregnancy for 4 weeks (28 days) after.
Give Rho(D) immune globulin IM within 72 hr of birth if an Rh-negative client had an Rh-positive newborn; watch 20 min for reaction.
Give varicella vaccine if nonimmune; avoid pregnancy for 1 month; second dose at 4 to 8 weeks.
Tdap is recommended before discharge for unvaccinated clients and close household contacts; breastfeeding is fine.
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2023.
Significant postpartum bleeding calls in obstetrics, anesthesia, and laboratory/blood bank staff together for coordinated response
A massive transfusion protocol uses roughly equal ratios of packed red cells, fresh frozen plasma, and platelets when hemorrhage is severe
StatPearls (NCBI Bookshelf) · Postpartum Hemorrhage · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
Ongoing red-colored lochia past the first week can signal subinvolution rather than normal progression to serosa/alba
A soft, boggy uterus with heavier-than-expected bleeding is the earliest sign that normal involution is becoming a hemorrhage complication
StatPearls (NCBI Bookshelf) · Physiology, Postpartum Changes · open the source →
📋 Family Adaptation6 parts
ATI Active Learning Template — System DisorderFamily Adaptation
Filled from ATI chapter 18, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 4 cite a source, 5 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Explores how new families bond with a newborn, from prenatal attachment through postpartum role adjustment. Reviews maternal role phases, signs of healthy or impaired parent-infant bonding, co-parent and sibling adaptation, and factors that can delay attachment.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from AAP, 2016.
Start skin-to-skin contact right after birth, once the mother is stable and responsive, and continue it for at least an hour to support bonding
Keep the practice going for cesarean births too, as soon as the mother is alert enough to respond to her newborn
Skin-to-skin holding also helps stabilize the newborn's temperature and blood glucose while supporting earlier breastfeeding
American Academy of Pediatrics · Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2023.
A personal history of depression or anxiety before pregnancy raises the chance of difficulty adjusting to the parenting role
Limited social support, intimate partner violence, and a traumatic birth experience are recognized contributors to strained family adjustment
Sleep deprivation combined with a negative attitude toward the baby is associated with poorer postpartum psychological adjustment
StatPearls (NCBI Bookshelf) · Perinatal Depression · open the source →
Assessment — Expected Findings
Not in your ATI chapter — filled from AAP.
Untreated postpartum depression is linked with disrupted parent-infant attachment and overall family dysfunction
Poor family adaptation associated with parental depression carries a higher risk of child abuse or neglect and of developmental delay
American Academy of Pediatrics · Perinatal Mental Health and Social Support · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
No laboratory test assesses family adaptation — it is observation and conversation.
Newborn labs continue as usual: bilirubin, glucose and the metabolic screen.
Maternal hemoglobin, since anemia worsens fatigue and low mood.
Thyroid studies if postpartum mood or energy changes persist — postpartum thyroiditis is missed often.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Structured depression screening with a validated tool.
Observe a feeding and a diaper change — what you see tells you more than what is reported.
Observe attachment behaviors: eye contact, holding en face, using the baby’s name, responding to cues.
Ask directly about support at home, and about safety.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Bonding: place the newborn skin-to-skin or en face with the parent right after birth.
Promote rooming-in for a quiet, private space that supports family bonding.
Support early breastfeeding initiation and help the parent notice newborn readiness cues.
Teach newborn care hands-on to build parental confidence over time.
Push hands-on contact as bonding: holding, bath time, feeds, diaper changes, simply watching the baby.
Give frequent praise and reassurance as the parent gains caregiving independence.
Give parents room to say out loud what worries them about looking after a baby.
Include each co-parent in newborn care teaching and encourage a hands-on role.
Guide the co-parent toward equal participation in newborn caregiving.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
No medication treats adaptation itself.
Treat pain adequately — unmanaged pain interferes with bonding and feeding.
Antidepressants where indicated; several are compatible with breastfeeding, so the choice is not medication or feeding.
Review every maternal medication for compatibility with breastfeeding rather than advising her to stop feeding.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Skin-to-skin contact in the first hour and often afterwards.
Rooming-in, which supports feeding cues and confidence.
Lactation consultation before difficulty becomes failure.
Sibling and grandparent visits; include partners in teaching rather than teaching around them.
Referral to home visiting, peer support or a new-parent group.
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Rubin’s phases: taking-in (dependent, needs care), taking-hold (ready to learn — teach here), letting-go (identity as a parent).
Teach during taking-hold. Teaching offered in taking-in is not retained.
Baby blues peak around day 5 and resolve by two weeks. Postpartum depression persists, worsens, or interferes with care — that one needs treatment.
Thoughts of harming herself or the baby are reported immediately, not at the next visit.
Normalize the difficulty. Most people expect to feel a bond instantly, and many do not.
Interprofessional Care
Not in your ATI chapter — filled from AAP.
Pediatric practices are encouraged to screen for parental depression at well-child visits and refer at-risk families to counseling
Dyadic (parent-child) therapy is an evidence-based referral option used to support the parent-infant relationship when adaptation is strained
American Academy of Pediatrics · Perinatal Mental Health and Social Support · open the source →
⚠️ What goes wrongComplications
Complications
Encourage clear verbal and nonverbal communication among the client, caregivers, and newborn.
Keep evaluating parenting skills for the client and any other caregivers.
Encourage ongoing support from grandparents and extended family.
Offer home visits and group sessions to address newborn care and parenting struggles.
Connect the family with social support networks for extra help.
Refer to community programs early to head off bigger parenting problems.
📋 Client Education and Discharge Teaching6 parts
ATI Active Learning Template — System DisorderClient Education and Discharge Teaching
Filled from ATI chapter 19, row by row from that chapter’s own sections — 12 of 12 rows have content.
10 rows came from outside your ATI chapter — 5 cite a source, 5 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers postpartum discharge teaching: perineal and breast care, activity and nutrition guidance, resuming sex and contraception, and warning signs of complications that require prompt reporting to the provider.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from CDC, 2024.
Teach caregivers to place the newborn on the back for every sleep, on a firm flat surface, with no soft bedding
Advise keeping the baby's sleep space in the same room as the parent, ideally until around 6 months, rather than bed-sharing
Centers for Disease Control and Prevention · Providing Care for Babies to Sleep Safely · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Risk of postpartum hemorrhage: prolonged or very fast labor, over-distended uterus, grand multiparity, retained fragments.
Risk of infection: cesarean, prolonged rupture of membranes, repeated vaginal exams, retained products.
Risk of VTE: cesarean, obesity, immobility, previous clot — pregnancy is already a clotting state for about 6 weeks after birth.
Risk of postpartum depression: previous depression, poor support, unplanned pregnancy, difficult birth, infant in special care.
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Fundus firm, midline, descending about 1 cm per day — no longer palpable by around day 10.
Lochia in order: rubra (days 1–3) → serosa (days 4–10) → alba (up to 6 weeks). It should get lighter, never redder.
Afterpains, stronger with breastfeeding and with each subsequent baby.
Baby blues in the first two weeks — tearful, labile, but able to care for herself and the baby.
Lochia returning to red, a boggy fundus, or one-sided calf pain are not expected findings.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Hemoglobin and hematocrit before discharge if blood loss was significant.
Rh status and Coombs — Rh-negative mother with an Rh-positive baby needs Rho(D) within 72 hours.
Rubella titre — if non-immune, MMR before discharge, and no pregnancy for 28 days afterwards.
Blood glucose if she had gestational diabetes; insulin needs fall sharply once the placenta is out.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Usually none — postpartum discharge is a clinical assessment, not an imaging one.
Ultrasound if retained placental fragments are suspected because bleeding persists.
Venous Doppler for a swollen, painful calf.
Depression screening with a validated tool before discharge and again at the follow-up visit.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Not in your ATI chapter — filled from StatPearls, 2024.
Teach the client to self-monitor lochia and report red-colored discharge that persists past the first week rather than fading toward serosa/alba
Confirm the client can verbalize expected involution changes (fundal descent, lochia progression) before considering discharge teaching complete
StatPearls (NCBI Bookshelf) · Physiology, Postpartum Changes · open the source →
Medications
Not in your ATI chapter — filled from StatPearls, 2023.
An Rh-negative mother of an Rh-positive infant should receive Rho(D) immune globulin within 72 hours of birth before or shortly after discharge
A rubella-nonimmune mother should get the MMR vaccine as soon as possible postpartum and before leaving the facility
After MMR vaccination, counsel the client to avoid becoming pregnant for 28 days because the vaccine contains live attenuated virus
From this module — built from the notes above on this page, not a section of the ATI chapter.
Perineal care: peri-bottle front to back after every void, pat dry, change pads every 2–4 hours.
Ice for the first 24 hours to the perineum, then warm sitz baths.
Stool softener and fluids — the first bowel movement is feared more than it needs to be, and constipation makes it worse.
Pelvic floor exercises once comfortable.
Teach when to resume activity, driving and intercourse per the provider — and that contraception is needed before the first period returns.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Perform hand hygiene before/after toileting and before breastfeeding; clean perineum front to back, no tampons while bleeding.
Breastfeed on demand 8 to 12 times/24hr; alternate starting breast each feeding.
For engorgement: warm compress before feeding, cold compress between feeds; empty breast fully.
Sore nipples: dab with breast milk and let air-dry after feeding.
Not breastfeeding: wear a supportive bra continuously for 72 hr; avoid nipple stimulation and warm water on breasts.
Nonlactating clients need about 1,600 to 2,400 kcal/day; lactating clients need roughly 2,000 to 2,800 kcal/day.
Continue prenatal vitamins until 6 weeks postpartum.
Interprofessional Care
Not in your ATI chapter — filled from AAP.
Arrange pediatric follow-up that includes screening the mother for depression, since this is now a recommended part of well-child visits
Refer families showing signs of strained adjustment to counseling or dyadic therapy rather than waiting for the comprehensive postpartum visit
American Academy of Pediatrics · Perinatal Mental Health and Social Support · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from CDC, 2024.
Teach the client to seek immediate care for severe headache, vision changes, dizziness, or fainting after discharge
Chest pain, irregular heartbeat, trouble breathing, or severe abdominal pain are also urgent warning signs to report right away
Thoughts of harming herself or the baby require immediate medical attention, not a wait-and-see approach
These warning signs apply for a full year after delivery, not just the first days home
Centers for Disease Control and Prevention · Urgent Maternal Warning Signs Educational Materials, HEAR HER Campaign · open the source →
📋 Complications of the Postpartum Period6 parts
ATI Active Learning Template — System DisorderComplications of the Postpartum Period
Filled from ATI chapter 20, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 3 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter reviews postpartum emergencies: DVT and pulmonary embolism, coagulopathies like ITP and DIC, postpartum hemorrhage, uterine atony, subinvolution, uterine inversion, retained placenta, and lacerations or hematomas requiring rapid nursing recognition and intervention.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from StatPearls, 2023.
Giving oxytocin 10 international units IV or IM during or right after delivery of the placenta, for every birth, is the main strategy to prevent hemorrhage
Assessing uterine tone immediately after delivery allows atony to be caught and treated before major blood loss develops
Identifying high-risk clients before delivery allows the team to plan delivery setting and specialist availability in advance
StatPearls (NCBI Bookshelf) · Postpartum Hemorrhage · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
DVT/PE: cesarean birth, immobility, obesity, smoking, preeclampsia, age over 40, prior thromboembolism.
DIC triggers, commonest first: abruptio placentae, then amniotic fluid embolism, fetal demise, severe preeclampsia/HELLP, sepsis.
Coagulopathy workup: CBC with differential, blood type and crossmatch.
PPH labs: Hgb and Hct, PT/coagulation profile, type and crossmatch.
Subinvolution: cultures (blood, intracervical, intrauterine) to rule out endometritis/infection.
Retained placenta: monitor Hgb and Hct for ongoing blood loss.
Diagnostic Procedures
DVT confirmed via Doppler ultrasound, CT, or MRI.
Uterine atony: provider may do bimanual compression or manual exploration for retained fragments.
Intrauterine tamponade balloon can be placed to control atony-related hemorrhage.
Hysterectomy considered if bleeding/atony fails to resolve with other measures.
Retained placenta: provider manually separates and removes the placenta.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Heparin given by continuous IV infusion titrated to coagulation studies; keep protamine sulfate available as antidote.
Monitor aPTT, targeting 1.5 to 2.5 times control value, with no bleeding signs.
Warfarin: monitor PT/INR; keep phytonadione available as antidote for prolonged clotting times.
PE: position client semi-Fowler's with head of bed elevated; give oxygen by mask.
DIC: watch IV/injection/laceration/episiotomy sites for bleeding; transfuse platelets, clotting factors, blood products as ordered.
PPH: calculate quantitative blood loss right after birth; weigh saturated pads/clots, subtract irrigation fluid.
PPH: massage boggy fundus, assess for bladder distention, insert catheter as needed; give isotonic IV fluids and blood products.
Give oxygen at 10 L/min via nonrebreather mask and monitor oxygen saturation during hemorrhage.
Oxytocin: watch for water-intoxication signs (lightheadedness, nausea, vomiting, headache) that can progress to seizures, coma, or death.
Medications
Heparin: anticoagulant given IV as initial treatment for DVT and acute PE to stop new/enlarging clots.
PE treated with the same anticoagulants as DVT; thrombolytics may also be prescribed to dissolve existing clots.
Alteplase: thrombolytic with adverse effects/contraindications similar to anticoagulants.
Oxytocin: uterine stimulant that promotes contractions, used to control postpartum hemorrhage.
Medication management for uterine atony and subinvolution follows the same protocol as for postpartum hemorrhage.
Subinvolution: antibiotics may be prescribed to prevent or treat infection.
Therapeutic Procedures
ITP unresponsive to treatment may require long-term corticosteroids, immunoglobulin, or splenectomy.
DIC: hysterectomy performed by the provider if indicated to control bleeding.
Subinvolution: D&C removes retained placental fragments or debrides the placental site.
Uterine inversion: provider manually replaces and repositions the uterus.
Lacerations: provider repairs and sutures the episiotomy or laceration.
Hematoma: provider ligates the bleeding vessel or surgically evacuates clotted blood.
💬 Around the patientClient Education · Interprofessional Care
Client Education
DVT prevention: avoid standing/sitting too long, elevate legs, don't cross legs, drink 2 to 3 L of fluid daily.
Thrombophlebitis: elevate the limb above heart level, apply warm moist compresses, never massage the affected leg.
Wear antiembolism stockings if at high risk for venous insufficiency; measure leg circumference regularly.
On anticoagulants: report bleeding gums/nose, heavier vaginal bleeding, blood in urine, or easy bruising.
Warfarin requires contraception because it's teratogenic; avoid estrogen contraceptives, which raise thrombosis risk.
Anticoagulant precautions: skip aspirin/ibuprofen, use an electric razor and soft toothbrush, avoid alcohol.
Avoid rubbing/massaging legs and prolonged sitting or leg-crossing while on anticoagulants.
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2023.
Major hemorrhage triggers a coordinated response across obstetrics, anesthesiology, and the blood bank/laboratory
A massive transfusion protocol delivers packed red cells, fresh frozen plasma, and platelets in roughly equal ratios during severe bleeding
Interventional radiology and general surgery may be brought in when bleeding is not controlled by first-line measures
StatPearls (NCBI Bookshelf) · Postpartum Hemorrhage · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
Postpartum hemorrhage is now defined as over 1000 mL of cumulative blood loss with signs of hypovolemia within 24 hours of birth, regardless of delivery type
Causes are organized around the '4 Ts': tone (uterine atony causes about 70% of cases), trauma, tissue, and thrombin/coagulopathy
A woman can lose more than 1000 mL before tachycardia, tachypnea, or hypotension become apparent, so bleeding can be underestimated
A soft, boggy, poorly contracted uterus is the hallmark finding of atony-related hemorrhage
StatPearls (NCBI Bookshelf) · Postpartum Hemorrhage · open the source →
ATI Active Learning Template — System DisorderPostpartum Infections
Filled from ATI chapter 21, row by row from that chapter’s own sections — 12 of 12 rows have content.
4 rows came from outside your ATI chapter — 4 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter reviews postpartum infections such as endometritis, wound infections, mastitis, and urinary tract infections, covering risk factors, hallmark findings like fever, and nursing priorities to catch and treat them before septicemia develops.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from StatPearls, 2023.
Cesarean birth raises endometritis risk 5 to 20 times compared with vaginal birth, so limiting unnecessary cervical exams and prolonged labor/rupture of membranes helps reduce exposure
Screening and treating Group B Streptococcus colonization and managing chorioamnionitis promptly are part of reducing infection risk
Good hand hygiene and sterile technique during any invasive procedure (manual placental extraction, operative delivery) lower ascending infection risk
UTI: urine that's cloudy, blood-tinged, malodorous, or has visible sediment.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Cultures (blood, intracervical, or intrauterine) identify the causative organism.
Elevated WBC count (leukocytosis) supports an infection diagnosis.
Diagnostic Procedures
Urinalysis checks for WBCs, RBCs, protein, and bacteria to confirm a UTI.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Get frequent vital signs; assess pain, fundal status, lochia, incisions, and breasts.
Use aseptic technique, hand hygiene, and gloves during labor, birth, and postpartum care.
Start IV access and give broad-spectrum antibiotics (penicillins, cephalosporins, clindamycin, gentamicin).
Offer comfort measures such as warm blankets or cool compresses based on findings.
UTI: obtain a clean-catch urine sample before starting antibiotics.
UTI: give acetaminophen for discomfort; teach front-to-back perineal wiping.
UTI: encourage fluid intake of 3,000 mL/day to help flush bacteria.
Medications
Not in your ATI chapter — filled from StatPearls, 2023.
First-line IV therapy for postpartum endometritis is clindamycin 900 mg every 8 hours plus gentamicin, dosed at 5 mg/kg once daily or by weight-based interval dosing
Ampicillin 2 g IV every 6 hours is added when the client is Group B Streptococcus-positive or not improving within 48 hours
Antibiotics continue until the client has been afebrile for at least 24 hours; routine oral follow-up antibiotics are not supported after clinical improvement
Mild superficial surgical site infections can be treated with an oral agent such as cephalexin, while deeper wound infections need the wound opened and broader-spectrum coverage
StatPearls (NCBI Bookshelf) · Postpartum Infection · open the source →
Therapeutic Procedures
Provider may need to open, drain, or debride an infected wound.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Report worsening symptoms promptly and finish the full antibiotic course.
Practice thorough hand hygiene and perineal care; eat a high-protein diet to aid healing.
Endometritis: expect vaginal/blood cultures, IV antibiotics, and analgesics for pain.
Keep bonding with the newborn during treatment for infection.
Wound infection: wound care, IV antibiotics, sitz baths, front-to-back perineal hygiene.
Mastitis: wash hands before feeding and keep breasts clean.
Mastitis: ensure proper latch, release the newborn's grasp before unlatching, empty breasts fully each feeding.
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2023.
Persistent spiking fever despite 3 to 5 days of antibiotics should prompt evaluation for septic pelvic thrombophlebitis, often needing imaging and interventional radiology input
Suspected necrotizing fasciitis is a surgical emergency requiring immediate general surgery consultation for debridement alongside broad-spectrum antibiotics
StatPearls (NCBI Bookshelf) · Postpartum Infection · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
Postpartum fever is an oral temperature of 38.0 degrees C (100.4 degrees F) or higher on 2 of the first 10 days, excluding the first 24 hours
Untreated postpartum endometritis carries a mortality rate cited at roughly 17%, underscoring why prompt antibiotic therapy matters
Surgical site infection affects about 2% to 7% of cesarean births and can progress from superficial to deep incisional infection if untreated
StatPearls (NCBI Bookshelf) · Postpartum Infection · open the source →
📋 Postpartum Mental Health Disorders6 parts
ATI Active Learning Template — System DisorderPostpartum Mental Health Disorders
Filled from ATI chapter 22, row by row from that chapter’s own sections — 12 of 12 rows have content.
6 rows came from outside your ATI chapter — 6 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Postpartum mood disorders span three severities: blues (up to 85% of clients, resolves within 2 weeks), depression (within 12 months, affects 1 in 8), and psychosis (onset within 2 weeks, psychiatric emergency needing safety monitoring).
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from USPSTF, 2019.
Cognitive behavioral therapy or interpersonal therapy counseling, offered to at-risk pregnant or postpartum clients, is graded a B recommendation for preventing perinatal depression
This counseling is recommended up to one year postpartum for clients with a depression history, subthreshold symptoms, low income, or recent partner violence
Trial evidence shows these counseling interventions lower the likelihood of perinatal depression by about 39%
U.S. Preventive Services Task Force · Perinatal Depression: Preventive Interventions, Final Recommendation Statement · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Rapid drop in estrogen and progesterone after delivery
Psychosis includes hallucinations, delusions, obsessive behaviors — a psychiatric emergency
Psychosis carries real risk of harm to self or the newborn
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from StatPearls, 2023.
TSH and free T4 are checked to rule out postpartum thyroiditis, which can mimic mood and energy symptoms of depression
Thyroid peroxidase antibodies are positive in about 60% to 85% of postpartum thyroiditis cases, especially during the hypothyroid phase
High-risk clients (for example those with a personal history of thyroid disease) warrant repeat TSH screening at 3 and 6 months postpartum
StatPearls (NCBI Bookshelf) · Postpartum Thyroiditis · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
The Edinburgh Postnatal Depression Scale is a 10-item, self-report tool scored 0 to 30 and takes only a few minutes to complete
A score of 13 or higher on the Edinburgh scale is associated with increased risk for perinatal depression
Many practices act on a lower cutoff, around 9 to 10, or on any positive answer about self-harm thoughts, to trigger referral
The PHQ-9 and GAD-7 are alternative screening tools used alongside or instead of the Edinburgh scale
StatPearls (NCBI Bookshelf) · Perinatal Depression · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Give early prenatal teaching on blues/depression symptoms so they're caught early
Screen every client for mood disorders across pregnancy and postpartum; recheck for depression before discharge and again at 4 weeks
Watch parent-newborn interactions and encourage bonding activities
Track the client's mood and affect over time
Tell the client to call the provider as soon as symptoms start or if they linger
Encourage open communication of feelings and reinforce the client's sense of control
Stress the importance of taking prescribed medication as directed
Share information on community mental health resources
Directly ask about thoughts of self-harm, suicide, or hurting the newborn; safety comes first
Medications
Antidepressants can be prescribed when indicated
Antipsychotics and mood stabilizers are used for postpartum psychosis
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
Electroconvulsive therapy is used for postpartum psychosis or severe depression that has not responded to medication
Transcranial magnetic stimulation is a non-drug option that has been used for postpartum depression
StatPearls (NCBI Bookshelf) · Perinatal Depression · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Rest and nap whenever the newborn sleeps
Make time for self-care
Keep all postpartum follow-up appointments, especially with risk factors present
Look into community resources such as support groups
Pursue counseling if needed
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2023.
Suspected postpartum psychosis is a psychiatric emergency needing immediate psychiatric evaluation and likely hospitalization if suicide or infant-harm risk is present
Pediatric well-child visits are recommended as an additional point to screen mothers for depression and route them to counseling or dyadic therapy
StatPearls (NCBI Bookshelf) · Postpartum Psychosis · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
Postpartum psychosis typically emerges within days to the first six weeks after birth and can include delusions, hallucinations, and disorganized thinking
A prior episode of postpartum psychosis or a personal/family history of bipolar disorder or psychosis are the strongest known risk factors for it
Untreated maternal depression is linked to disrupted parent-infant bonding and a higher risk of child abuse, neglect, and developmental delay
StatPearls (NCBI Bookshelf) · Postpartum Psychosis · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
The greatest hemorrhage risk is the first 1–2 hours after birth.
Boggy uterus DEVIATED to the right + a pad saturated in 10 minutes = bladder distension → have her void first. Fix the cause by the least invasive route before uterotonics. Methylergonovine IM only if bleeding continues after the bladder is empty; bimanual compression is a provider-level last resort.
Boggy fundus above the umbilicus at 2 hours → massage the fundus and assess the bladder. Teaching, capping the newborn and feeding math all wait.
Severe perineal pain 30 minutes after birth → assess for a hematoma BEFORE analgesia or ice. Assess before you intervene; circulation before comfort.
Perineal comfort timing: ice for the first 24 hours, then a warm sitz bath 15–20 minutes. At 36 hours the answer is the sitz bath.
Involution: the fundus descends ~1 cm/day. At 24 hours it should be about 1 cm below the umbilicus, and midline.
Lochia: rubra dark red days 1–3, serosa pinkish-brown days 4–10, alba yellow-white day 10 to about 6 weeks.
Postpartum hemorrhage = >500 mL vaginal or >1,000 mL cesarean. Weigh saturated items — 1 g = 1 mL.
Postpartum blues resolve by about 2 weeks. Persistent sadness, fatigue and inability to care for the newborn at2 weeks = postpartum depression → discuss support and refer. Nurses refer, they do not diagnose, and never advise stopping breastfeeding for mood.
Expect postpartum diuresis and diaphoresis. A pulse in the 50s–60s is normal postpartum bradycardia.
Calc — oxytocin for PPH: 20 units/1,000 mL at 60 mL/hr → 60 × 20 ÷ 1,000 = 1.2 units/hr.
The fundus RISES to the umbilicus at 1 hour, then descends ~1 cm/day; halfway to the symphysis by day 6; not palpable after ~2 weeks. Uterine weight falls from ~1,000 g to 100 g by 6 weeks.
NEVER express clots until the uterus is firmly contracted — pushing on an uncontracted uterus can invert it.
Lochia by pad staining: scant <2.5 cm · light 2.5–10 · moderate >10 · heavy = one pad saturated in an hour. One pad in 15 minutes, or pooling under the buttocks, is excessive.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
