Focus Listing Risk Factors
PPH(postpartum  Retained placenta (OR 3.5, 95% CI 2.1-
hemorrhage) 5.8)
 Failure to progress during the second
stage of labor (OR 3.4, 95% CI 2.4-4.7)
 Placenta accreta (OR 3.3, 95% CI 1.7-
6.4)
 Lacerations (OR 2.4, 95% CI 2.0-2.8)
 Instrumental delivery (OR 2.3, 95% CI
1.6-3.4)
Puerpueral Infection  History of cesarean delivery.
 Premature rupture of membranes.
 Frequent cervical examination (Sterile
gloves should be used in examinations.
 Internal fetal monitoring.
Risk Identification/ Intervention
Estimation of blood loss (this
may be done by counting the
number of saturated pads, or by
weighing of packs and sponges
used to absorb blood; 1 milliliter
of blood weighs approximately
one gram)
Assess the location of the uterus
and degree of the contractility of
the uterus/ Massage boggy
uterus using one hand and place
the second hand above the
symphysis pubis.
Monitor vital signs including
systolic and diastolic blood
pressure, pulse and heart rate.
Check for the capillary refill and
observe nail beds and mucous
membranes.
Note for the presence of vulvar
hematoma and apply an ice pack
if indicated.
Measure a 24-hour intake and
output. Observe for signs of
voiding difficulty.
Observe for reports of persistent
perineal pain or feeling of
vaginal fullness. Apply
counterpressure on labial or
perineal lacerations
Monitor and record Hematocrit
(red blood cell count)
Review prenatal, intrapartal, and
postpartal record.
Demonstrate and maintain
a strict hand-washing policy for
  Preexisting pelvic infection including staff, client, and visitors.
bacterial vaginosis.
 Diabetes. Instruct the proper disposal of
 Nutritional status. contaminated linens, dressings,
 Obesity. and peripads. Maintain isolation,
if indicated.

Demonstrate correct perineal

cleaning after voiding and
defecation, and frequent
changing of peripads.

Demonstrate proper fundal

massage. Review importance
and timing of the procedure.
Monitor temperature, pulse, and
respirations. Note presence of
chills or reports of anorexia or
malaise.

Observe perineum/incision for

other signs of infection (e.g.,
redness, edema,
ecchymosis, discharge and
approximation [REEDA scale]).
Note subinvolution of uterus,
extreme uterine tenderness.
Thrombophlebitis Have Varicose veins Monitor capillary refill time;
Assess for positive Homans’ sign
(calf pain at dorsiflexion of the
foot).

Assess circulation, asymmetry,

sensory and motor function of
extremity; Observe edema from
groin to foot; Measure and
record calf/thigh circumference
of both legs as appropriate.
Report proximal progression of
inflammation, traveling pain.

Assess respiration and

auscultate for lung sounds,
noting crackles or friction rub.
Investigate reports of chest pain
or feelings of anxiety.
Instruct client to avoid
massaging or rubbing the
 affected extremity.

Maintain bed rest with elevation

of feet and lower legs in above
heart level during the acute
phase.

Elevate client’s legs when resting

or sitting in a chair.

Instruct client to avoid crossing

the legs or wear constrictive
clothing.

Encourage increased fluid intake

Mastitis  Previous bout of mastitis while
breast-feeding.
 Sore or cracked nipples — although
mastitis can develop without
broken skin.
 Wearing a tightfitting bra or putting
pressure on your breast when
using a seat belt or carrying a
heavy bag, which may restrict milk
flow.
of 2500 ml/day unless
contraindicated
Observe the mother
breastfeeding her infant to
assess the possible latching
problems.
Assist the patient with helping
her develop a plan for proper
latching techniques with her
newborn before the end of the
office visit.

Demonstrate to the patient how

to apply warm compresses to
right breast every 2 hours.

 Educated the patient about the

early signs and symptoms of
Mastitis before the end of the
office visit.
Postpartum Induced  High blood pressure during your Weigh patient regularly. Tell
Hypertension and most recent pregnancy. patient to record weight at
Eclampsia  Obesity. home in between visits.
 Having multiples.
 Chronic high blood pressure. Note signs of progressive or
 Diabetes. excessive edema i.e.,
epigastric/RUQ pain, cerebral
symptoms, nausea, vomiting).
Assess for possible eclampsia.

Assess patient’s/couple’s
knowledge of the disease
 process. Provide information
about pathophysiology of PIH,
implications for mother and
fetus; and the rationale for
interventions, procedures, and
tests, as needed.

Provide information about

signs/symptoms indicating
worsening of condition, and
instruct patient when to notify
healthcare provider.

Have patient informed of health

status, results of when tests, and
fetal well-being.

Educate patient on how to

monitor her own weight at
home, and to notify healthcare
provider if gain is in excess of 2
lb/wk, or 0.5 lb/day.

Postpartum psychosis  Personal or family history of Assess the woman’s

bipolar disorder, or a previous psychological health even before
psychotic episode. the delivery.

Assess her history of illnesses to

determine if she needs any
counseling prior to her delivery
to avoid postpartum depression.

Assist the woman in planning for

her daily activities, such as her
nutrition program, exercise, and
sleep.

Recommend support groups to

the woman so she can have a
system where she can share her
feelings.

Advise the woman to take some

time for herself every day so she
can have a break from her
regular baby care.

Encourage the woman to keep in

touch with her social circle as
they can also serve as her
support system.