Care Post-vaginal Delivery
摘要
During the postpartum hospital stay, early warning criteria—such as blood pressure < 90 or > 160 mmHg, diastolic blood pressure > 100 mmHg, heart rate < 50 or > 120 beats per minute, respiratory rate < 10 or > 30 breaths per minute, oxygen saturation on room air at sea level < 95%, oliguria (< 35 mL per hour for more than 2 hours), as well as agitation, confusion, or unresponsiveness—should be monitored to promptly identify potentially critical illnesses requiring proper interventions. Baby-friendly initiatives, such as skin to skin contact and rooming in, should be promoted in every healthcare setting. To reduce postpartum pain, nonsteroidal anti-inflammatory drugs are the most effective medications. Prophylactic antibiotics decrease the incidence of infections after both severe obstetric lacerations and operative vaginal delivery. Postpartum fever, associated with lower abdominal pain and uterine tenderness, tachycardia, and purulent lochia, are supportive findings for a clinical diagnosis of endometritis that is commonly treated with clindamycin 900 mg every 8 hours plus gentamicin 5 mg/kg every 24 hours until 24 hours afebrile. An adequate discharge usually occurs after 48 hours in case of vaginal delivery, and may be even anticipated if both the mother and the baby are recovering well. A comprehensive postpartum visit should take place no later than 12 months after delivery and should focus on assessing the physical, social, and psychological well-being of the woman. Long-acting reversible contraception is safe and highly effective for postpartum contraception. Immediate postpartum IUD placement should be offered as a useful and cost-effective option for postpartum contraception, as it results in more women desiring IUDs having it in place at 6 weeks postpartum compared to placing at the postpartum visit. At least 150 minutes of moderate intensity aerobic activity per week is recommended during the postpartum period, while recommendations about return to work and resumption of vaginal intercourse should be tailored according to women’s individual wishes and needs. Screening for postpartum depression with validated instruments should be performed during the comprehensive postpartum visit to address women with screen-detected depression for further detailed evaluation.