Postpartum red flags

Q:What red flags should I watch out for postpartum that could indicate something is wrong?

A: For most women, postpartum recovery is uneventful, but it is a period of recovery, nonetheless. The body and all its systems are returning to prepregnancy “normal.” Women experience this time differently, so it is important to follow the advice of your health care provider for follow-up and instructions, as well as trust yourself to know when something is just not right. The most common problems after delivery are infections, excessive bleeding, venous thromboembolism (forming abnormal clots in blood vessels), high blood pressure problems and mood disorders.

Infections can occur after vaginal or cesarean delivery and may involve any area with stitches (such as a cesarean incision or a vaginal laceration) or the uterus itself. Other systems may also be at higher risk of infection due to pregnancy-related changes and the individual circumstances of the delivery. The red flags for infection include fever, new onset of pain in a surgical site, and redness or pus where there are stitches.

Bleeding after delivery is usually like a heavy menstrual cycle and can last for up to six weeks. Though it generally gets lighter over time, it may wax and wane a bit. That said, if the bleeding becomes much heavier, such as soaking a pad every hour or passing clots bigger than a lemon, seek medical attention. Passing clots that can be described as the size of any coin is generally not concerning, but when in doubt, check with your provider.

The risk of developing clots in blood vessels is increased in pregnancy, and it continues after delivery. If an abnormal clot forms in the legs (called deep vein thrombosis, or DVT), one may notice uneven swelling of the legs or ankles or a notable increase in swelling over a short time. Just as swelling of the lower legs is common in late pregnancy, it is in the early postpartum period as well. If clots travel to the arteries to the lungs (pulmonary embolism), the patient may experience shortness of breath or chest pain. These are emergency symptoms, and you should seek medical help.

If high blood pressure was noted during pregnancy, closer
monitoring is often recommended after delivery. Sometimes serious elevations of blood pressure are associated with severe headache or visual changes, so these should get your attention, even if there was no problem with your blood pressure during pregnancy.

The final area of concern is postpartum mood disorders. Most women have “baby blues” to some degree, and this generally resolves over the first few weeks. Both postpartum depression and postpartum psychosis are more serious and have risks for both mother and child. The usual symptoms of depression may be seen, but thoughts of harming yourself or your child also should be evaluated urgently.

I always advise patients to trust that they know their bodies best. If you really feel something isn’t right, seek medical help. It may turn out to be all right and a normal part of the process, or it may be the only sign of some of these problems.

—Karoline Puder, MD, chief of obstetric services at Detroit Medical Center’s Hutzel Women’s Hospital


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