Postpartum Heart Rate Still High 6 Weeks After Baby Birth

Serious postpartum complications are rare. The nigh common complications are

Inside the first 24 hours, the adult female's pulse rate begins to drop, and her temperature may be slightly elevated.

Vaginal discharge is grossly bloody (lochia rubra) for 3 to 4 days, and so becomes stake brown (lochia serosa), and after the next 10 to 12 days, it changes to yellowish white (lochia alba).

The uterus involutes progressively; after five to 7 days, it is business firm and no longer tender, extending midway between the symphysis and umbilicus. By ii weeks, it is no longer palpable abdominally and typically past iv to 6 weeks returns to a prepregancy size. Contractions of the involuting uterus, if painful (afterpains), may require analgesics.

During the first week, urine temporarily increases in volume and becomes more dilute as the boosted plasma book of pregnancy is excreted. Intendance must exist taken when interpreting urinalysis results because lochia can contaminate the urine.

Considering claret volume is redistributed, hematocrit may fluctuate, although information technology tends to remain in the prepregnancy range if women do non hemorrhage. Considering the white blood count (WBC) count increases during labor, marked leukocytosis (upwards to 20,000 to thirty,000/mcL) occurs in the outset 24 hours postpartum; WBC count returns to normal inside 1 week. Plasma fibrinogen and erythrocyte sedimentation rate (ESR) remain elevated during the first week postpartum.

Risk of infection, hemorrhage, and excessive hurting must be minimized. Women are typically observed for at least one to 2 hours after the 3rd stage of labor and for several hours longer if regional or general anesthesia was used during delivery (eg, by forceps, vacuum, or cesarean) or if the delivery was non completely routine.

Minimizing bleeding is the get-go priority; measures include

• Uterine massage

• Sometimes parenteral oxytocin

During the first hour later on the 3rd phase of labor, the uterus is massaged periodically to ensure that it contracts, preventing excessive bleeding.

If the uterus does non contract after massage lonely, oxytocin 10 units IM or a dilute oxytocin IV infusion (10 or 20 [up to fourscore] units/chiliad mL of Four fluid) at 125 to 200 mL/hour is given immediately afterwards delivery of the placenta. The drug is continued until the uterus is business firm; and then information technology is decreased or stopped. Oxytocin should not exist given as an IV bolus because severe hypotension may occur.

If haemorrhage increases, methergine 0.2 mg IM every 2 to 4 hours or misoprostol 600 to 1000 mcg given orally, sublingually, or rectally one time can be used to increase uterine tone. Methergine 0.2 mg orally every 6 to 8 hours can be continued for up to vii days if needed. Tranexamic acid 1 g IV can be given in addition; information technology must be given within 3 hours of delivery to be effective.

For all women, the post-obit must be available during the recovery period

• Oxygen

• Blazon O-negative blood or blood tested for compatibility

• Four fluids

If blood loss was excessive (≥ 500 mL), a complete blood count (CBC) to verify that women are not anemic is required before discharge. If blood loss was non excessive, CBC is not required.

After the kickoff 24 hours, recovery is rapid. A regular diet should be offered as presently as women desire food. Full ambulation is encouraged as soon as possible.

Exercise recommendations are individualized depending on the presence of other maternal disorders or complications. Usually, exercises to strengthen abdominal muscles can be started in one case the discomfort of delivery has subsided, typically inside 1 24-hour interval for women who deliver vaginally and subsequently (typically after 6 weeks) for those who deliver by cesarean. Whether pelvic floor (eg, Kegel) exercises are helpful is unclear, but these exercises tin begin as soon as the patient is ready.

If delivery was uncomplicated, showering and bathing are allowed, but vaginal douching is prohibited. The vulva should be cleaned from front end to back.

Immediately later on commitment, ice packs may help reduce pain and edema at the site of an episiotomy or repaired laceration; sometimes lidocaine foam or spray can be used to save pain.

Subsequently, warm sitz baths tin be used several times a day.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen 400 mg orally every 4 to 6 hours, work effectively on both perineal discomfort and uterine cramping. Acetaminophen 500 to k mg orally every four to 6 hours can likewise be used. Acetaminophen and ibuprofen appear to exist relatively safe during breastfeeding. Many other analgesics are secreted in breast milk.

If pain is significantly worsening, women should be evaluated for complications such as vulvar hematoma.

Urine retention, bladder overdistention, and catheterization should exist avoided if possible. Rapid diuresis may occur, especially when oxytocin is stopped. Voiding must be encouraged and monitored to prevent asymptomatic bladder overfilling. A midline mass palpable in the suprapubic region or height of the uterine fundus higher up the bellybutton suggests bladder overdistention. If overdistention occurs, catheterization is necessary to promptly relieve discomfort and to prevent long-term urinary dysfunction. If overdistention recurs, an indwelling or intermittent catheter may be needed.

Women are encouraged to defecate before leaving the infirmary, although with early belch, this recommendation is oft impractical. If defecation has non occurred within iii days, a balmy cathartic (eg, psyllium, docusate, bisacodyl) can be given. Avoiding constipation tin foreclose or assistance save existing hemorrhoids, which tin besides be treated with warm sitz baths. Women with an extensive perineal laceration repair involving the rectum or anal sphincter tin can be given stool softeners (eg, docusate).

Regional (spinal or epidural) or general anesthesia may filibuster defecation and spontaneous urination, in role by delaying ambulation.

Women who are seronegative for rubella should be vaccinated against rubella on the day of discharge.

Pregnant women who do not have evidence of immunity should exist given the first dose of the varicella vaccine after delivery and the 2nd dose 4 to 8 weeks later the first dose.

Additional vaccines may be recommended depending on maternal vaccination and health history.

Milk aggregating may crusade painful breast engorgement during early lactation.

For women who are going to breastfeed, the following are recommended until milk production adjusts to the infant's needs:

• Expressing milk past hand in a warm shower or using a chest pump betwixt feedings to relieve force per unit area temporarily (however, doing so tends to encourage lactation, and then it should exist done only when necessary)

• Breastfeeding the infant on a regular schedule

• Wearing a comfortable nursing bra 24 hours/24-hour interval

For women who are non going to breastfeed, the following are recommended:

• Business firm support of the breasts to suppress lactation because gravity stimulates the let-down reflex and encourages milk flow

• Refraining from nipple stimulation and transmission expression, which tin can increase lactation

• Tight binding of the breasts (eg, with a snug-fitting bra), common cold packs, and analgesics as needed, followed by firm support, to control temporary symptoms while lactation is beingness suppressed

Suppression of lactation with drugs is not recommended.

Transient depressive symptoms (baby blues) are very common during the first week after delivery. Symptoms (eg, mood swings, irritability, feet, difficulty concentrating, insomnia, crying spells) are typically mild and usually subside past 7 to 10 days.

A preexisting mental disorder, including prior postpartum depression, is probable to recur or worsen during the puerperium, then affected women should exist monitored closely.

• 1. Altenau B, Well-baked CC, Devaiah CG, Lambers DS: Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control. Am J Obstet Gynecol 217 (3):362.e1–362.e6, 2017. doi: 10.1016/j.ajog.2017.04.030 Epub 2017 Apr 25.

The woman and infant may be discharged inside 24 to 48 hours postpartum; some obstetric units belch them as early equally 6 hours postpartum if major anesthesia was non used and no complications occurred.

Serious bug are rare, but a abode visit, office visit, or phone call inside 24 to 48 hours helps screen for complications. A routine postpartum visit is usually scheduled at 3 to eight weeks for women with an uncomplicated vaginal delivery. If delivery was cesarean or if other complications occurred, follow-up may exist scheduled sooner.

Normal activities may be resumed as before long as the woman feels fix.

Sex activity after vaginal commitment may be resumed as soon as desired and comfortable; nonetheless, a laceration or episiotomy repair must be allowed to heal commencement. Sexual practice afterward cesarean delivery should be delayed until the surgical wound has healed.

Pregnancy must be delayed for 1 month if women were vaccinated against rubella or varicella. Also, subsequent obstetric outcomes are improved by delaying conception for at least vi months but preferably 18 months afterwards commitment.

To minimize the take chances of pregnancy, women should start using contraception every bit soon equally they are discharged. If women are not breastfeeding, ovulation normally occurs about four to half dozen weeks postpartum, two weeks before the get-go menses. However, ovulation can occur earlier; women accept conceived every bit early on as 2 weeks postpartum. Women who are breastfeeding tend to ovulate and menstruate later, usually closer to vi months postpartum, although a few ovulate and menstruate (and get pregnant) equally quickly as those who are not breastfeeding.

Women should choose a method of contraception based on the specific risks and benefits of various options.

Breastfeeding condition affects choice of contraceptive. For breastfeeding women, nonhormonal methods are commonly preferred; amidst hormonal methods, progestin-merely oral contraceptives, depot medroxyprogesterone acetate injections, and progestin implants are preferred considering they do not affect milk production. Estrogen-progesterone contraceptives can interfere with milk production and should not be initiated until milk product is well-established. Combined estrogen-progestin vaginal rings can be used subsequently 4 weeks postpartum if women are non breastfeeding.

A diaphragm should be fitted but subsequently complete involution of the uterus, at 6 to 8 weeks; meanwhile, foams, jellies, and condoms should be used.

Intrauterine devices may exist placed equally shortly as immediately after delivery of the placenta, but placement later 4 to half-dozen weeks postpartum minimizes take a chance of expulsion.

Women who have completed their family may choose permanent contraception, which are surgical procedures that involve resecting or ligating part of the fallopian tubes. The procedures tin be done during the postpartum period, at the fourth dimension of cesarean delivery, or subsequently the postpartum menstruation. These procedures are considered permanent and irreversible.

Postpartum Heart Rate Still High 6 Weeks After Baby Birth

Source: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-care

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