Guideline 12

Guideline 12: Postpartum History and Physical Assessment

Purpose 

A thorough nursing assessment of the client's physical and emotional health after childbirth will provide essential information to enable the nurse to develop a care plan that supports the most appropriate interventions to promote health and the nurturing of a positive parent- infant relationship postpartum. The postpartum period is also a key time to monitor for pregnancy- associated problems and provide early interventions as the maternal mortality rate has been steadily increasing since 1999. Rates in 2022 were 14.4 deaths per 100,000 live births for women younger than 25, 21.1 for those ages 25–39, and 87.1 for those age 40 and older. The rate for women age 40 and older was six times higher than the rate for women younger than age 25. The top causes of pregnancy related deaths in the United States are heart conditions, infections, bleeding, blood clots and high blood pressure. The risk of pregnancy-related deaths in African-American and American Indian/Alaska Native women is two to four times higher than those of white women.

Process 

A head to toe nursing assessment should be done at the first visit post-partum. Areas that require further assessment and follow up (such as mental health status), should be noted and explored in further visits as soon as possible. Some of these areas may be assessed through therapeutic conversation, rather than hands-on assessment, per nurse's discretion. Physical and mental health findings not within normal limits may necessitate a care plan for continued follow up at subsequent visits. The body systems to consider for a head-to-toe assessment are listed in Table 1. Blood pressure should be monitored at each visit up to 6 weeks postpartum. In hypertensive clients, BP should be monitored at least 6 weeks postpartum and further until hypertension is resolved (see Perinatal Blood Pressure Assessment Guideline). Note that secondary postpartum hemorrhage can happen between 24 hours and 12 weeks after giving birth. 
Clients with chronic health issues (e.g. asthma, renal disease, cardiac disease, orthopedic issues) may need some additional case management services. Signs and symptoms of concern or client concerns should be referred to the appropriate provider, and the referral should be documented (see Table 1 guidelines for when to refer). 

Table 1

References 

1. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf
2. Bates' Nursing Guide to Physical Exam and History Taking (2011) 
3. Dillon, Patricia. Nursing Health Assessment Student Applications. Second Edition. F.A. Davis Company, 2007. 
4. 2014 Evidence-Based guideline for the management of high blood pressure in adults. Report from the Panel Members Appointed to the Eighth Joint National Committee. JAMA .520-507:(5)311;2014 .doi:10.1001/jama.2013.284427. 
5. Alexander J, Thomas PW, Sanghera J. Treatments for secondary postpartum haemorrhage. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002867. DOI: 10.1002/14651858.CD002867. 
6. CDC public health grand rounds. Meeting the Challenges of Measuring and Preventing Maternal Mortality in the United States. November 14, 2017. https://archive.cdc.gov/www_cdc_gov/grand-rounds/pp/2017/20171114-presentation-maternal-mortality-H.pdf 
7. CDC Chronic Disease https://www.cdc.gov/chronic-disease/?CDC_AAref_Val=https://www.cdc.gov/chronicdisease/resources/publications/aag/maternal.htm  
8. NICE Clinical Guidelines, No. 62.National Collaborating Centre for Women's and Children's Health (UK). 2008 Mar. Accessed https://www.ncbi.nlm.nih.gov/books/NBK573778/ 
   

Feedback Form