Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Postpartum care

Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Psychiatry/Health Psychology, Reproduction & Development, General Practice
Progress Test Topic(s)
Mental health, Women's health
A 24 year old Māori woman presents to her GP with vaginal bleeding 5 weeks after the spontaneous vaginal birth of her healthy baby boy. She is tired, tearful and finds it difficult to bond with her son because she's feeling so 'low'. She stopped breast feeding 2 weeks ago due to breast pain.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the female reproductive tract
   - Anatomy and function of the breast and how the breast changes during pregnancy and lactation
   - Physiology of puerperium and lactation
   - Mechanisms of haemostasis, thrombus formation and its disturbance during pregnancy and the puerperium
   - Natural history of antenatal and postpartum mood disorders
   - Characteristics of post-partum psychosis
   - Prescribing during lactation; drug interactions in breast feeding
Clinical and Communication Skills 
   - Elicit a history from a woman with postpartum complications
   - Examination of the postnatal woman with bleeding; include abdomen, pelvic exam and speculum if indicated
   - Examination of the breast, taking into account normal differences between the lactating and non-lactating breast
   - Differential diagnosis of postpartum haemorrhage
   - Emergency management of severe postpartum haemorrhage
   - Investigate bleeding in a postnatal woman: full blood count, swabs, ultrasound
   - Investigate fatigue in a postnatal woman: full blood count, thyroid function tests
   - Screen for postnatal depression using the Edinburgh Post Natal Depression Score
   - Awareness of normal mother:baby attachment and bonding
   - Recognise and differentiate 'baby blues', postpartum depression and puerperial psychosis
   - Manage psychological disease in the puerperium
   - Assess maternal and baby safety (suicidal intent, harming herself and/or the baby)
   - Differential diagnosis and management of breast pain in the puerperium, specifically ensuring correct latch and excluding mastitis
   - Contraception options in breastfeeding women, importance of planning next pregnancy especially if first baby born by caesarean section
   - Opportunity to offer cervical smear if due
Personal and Professional Skills 
   - Recognise the social and psychological impact of having a baby
   - Recognise the role of the community midwife and GP in the postpartum management of mother and baby
   - Recognise the role of lactation consultant
   - Manage expectations; most people don't expect it to be as hard as it is
   - Perform intimate breast and pelvic examinations with sensitivity
   - Recognise the importance of timely multidisciplinary communication within maternal mental health team
Hauora Māori 
   - Consideration of access to cultural/spiritual support for patient/whānau
   - Competency in engaging in a family/whānau meeting, even if the patient is non-Māori (family members may be Māori)
   - Consideration of inequities in access to maternity and primary care health services for Māori
Population Health 
   - Recognise the morbidity and mortality rates from mental health disorders in the puerperium
   - Universal screening for maternal mental health disorders
   - Epidemiology of postnatal mental health disorders and postpartum haemorrhage
   - Organisation of breast care services
   - Benefits of breast feeding for women and their babies
   - Role of Baby Friendly Hospital Initiative in promoting breastfeeding, and importance of support of partner and family
Conditions to be considered relating to this scenario
lochia, endometritis, retained product of conception, trauma during birth, uterine atony, 'baby blues', postnatal depression, social stressors, drug induced
Less common but 'important not to miss'
pulmonary embolism, coagulopathies, thrombophilia, puerperal psychosis, puerperal sepsis
uterine arterio-venous malformation, choriocarcinoma
Related Scenarios
[Major depressive episode]