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Midwife Licensure Exam High-Risk Pregnancy & Complications (Recognize & Refer) — Postpartum ComplicationsCheat Sheet

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Postpartum Complications cheat sheet for Midwife Licensure Exam aspirants. If you could only take one sheet of paper into your review session, this is what it would look like. Professional Regulation Commission (PRC) — Board of Midwifery's most-tested concepts, all in one place.

Exam context

For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests High-Risk Pregnancy & Complications (Recognize & Refer) under a "Core" label, with Postpartum Complications in the 4th slot across 4 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of High-Risk Pregnancy & Complications (Recognize & Refer) questions. Date to watch: April and November 2026 (expected).

Postpartum Complications - Cheat Sheet

Your final 30-minute revision companion for postpartum hemorrhage, infection, mastitis, thrombophlebitis, and mood disorders. Every item here is exam-critical.

Sections

Formulas

Formula

PPH Diagnosis: >500 mL (vaginal) OR >1,000 mL (cesarean) OR hemodynamic instability

Meaning

Threshold blood loss OR signs of shock (tachycardia, restlessness, hypotension late)

Watch Out

Do NOT wait for hypotension — tachycardia and restlessness are earlier signs of shock. Hypotension is LATE.

When To Use

Any postpartum bleeding assessment — these are the cutoff numbers for PPH diagnosis

Common Values

Value

>500 mL

Symbol

—

Quantity

PPH threshold, vaginal delivery

Value

>1,000 mL

Symbol

—

Quantity

PPH threshold, cesarean delivery

Value

~1 cm (1 fingerbreadth) per day

Symbol

—

Quantity

Fundal descent rate

Value

day 10 postpartum

Symbol

—

Quantity

Fundus non-palpable by

Section Title

POSTPARTUM HEMORRHAGE (PPH)

Important Facts

The 4 Ts of PPH: TONE (atony—#1 cause), TRAUMA (lacerations/hematoma), TISSUE (retained placenta), THROMBIN (coagulation disorder).
Bright-red, steady bleeding with a FIRM fundus = TRAUMA, not atony. Look for cervical/vaginal tears or hematoma.
Fundus DEVIATED OFF MIDLINE (usually right) = FULL BLADDER. Empty the bladder immediately — it prevents uterine contraction.
FIRST action for boggy uterus = FUNDAL MASSAGE. Do this before drugs.
Risk factors for atony: overdistension (macrosomia, multiple gestation, polyhydramnios), prolonged/precipitous labor, high parity, oxytocin use, retained placenta.
Count and WEIGH pads to quantify blood loss accurately. Saturating 1 pad/hour = significant bleeding.
Ensure LARGE-BORE IV access (18-gauge or larger), establish 2 lines if heavy bleeding; send blood for type/cross, CBC, coagulation studies.
Keep woman WARM, FLAT, legs slightly elevated if shocky; give supplemental O₂; anticipate massive transfusion protocol.

Key Definitions

Term

Early (Primary) PPH

Example

Woman delivers vaginally; 2 hours later, fundus is boggy and lochia is heavy — assess for early PPH.

Definition

Blood loss >500 mL vaginal or >1,000 mL cesarean within the FIRST 24 HOURS postpartum.

Term

Late (Secondary) PPH

Example

Mother goes home after vaginal delivery; at 2 weeks postpartum, bright-red bleeding returns — suspect retained placenta or subinvolution.

Definition

Bleeding from 24 hours to 6–12 weeks postpartum, usually from retained placental fragments or subinvolution.

Term

Uterine Atony

Example

Fundus is soft and displaced; with massage, it firms — atony managed with massage and oxytocin.

Definition

Loss of uterine contractility; the uterus feels boggy and soft. THE NUMBER-ONE CAUSE of early PPH.

Term

Subinvolution

Example

At day 14 postpartum, fundus is still 2 cm above umbilicus — suspect subinvolution from retained placenta.

Definition

Slowed or incomplete return of the uterus to non-pregnant size; fundus remains high or boggy after day 10.

Diagrams To Know

Normal fundal descent: firm, at/below umbilicus postpartum, descends ~1 cm/day, non-palpable by day 10.
Lochia progression: RUBRA (dark red, days 1–3) → SEROSA (pinkish-brown, days 4–10) → ALBA (yellowish-white, up to 6 weeks).
Shock progression: tachycardia and restlessness (early) → tachypnea → pale, cold skin → hypotension (LATE—danger sign).

Formulas

Formula

OXYTOCIN: 10–40 units/L IV infusion OR 10 units IM (single dose)

Meaning

Oxytocin dose; IV infusion is standard for atony; IM for immediate effect.

Watch Out

Monitor for water intoxication with large IV volumes (hyponatremia). Do NOT push as IV bolus — always dilute.

When To Use

FIRST-LINE for uterine atony. Safe in hypertension and preeclampsia.

Formula

METHYLERGONOVINE: 0.2 mg IM (may repeat)

Meaning

Ergot alkaloid causing sustained uterine contraction.

Watch Out

CONTRAINDICATED IN HYPERTENSION/PREECLAMPSIA — raises BP dangerously. ALWAYS check BP before each dose.

When To Use

For atony AFTER delivery of placenta (not before, risk of placental entrapment).

Formula

CARBOPROST (15-methyl PGF2α): 250 mcg IM every 15–90 minutes (max 8 doses)

Meaning

Prostaglandin causing uterine contraction.

Watch Out

CONTRAINDICATED IN ASTHMA — causes bronchospasm. Common side effects: diarrhea, fever, flushing, shivering.

When To Use

If oxytocin/ergot fail; useful in resource-limited settings.

Formula

MISOPROSTOL: 600–1,000 mcg rectally or orally

Meaning

Prostaglandin E1; no refrigeration needed.

Watch Out

Side effect: fever/shivering. Not as potent as IV oxytocin; use as adjunct.

When To Use

Resource-limited settings (does not require cold chain).

Section Title

UTEROTONIC DRUGS FOR PPH

Important Facts

OXYTOCIN = safest, first-line. No contraindications in hypertension.
METHYLERGONOVINE = contraindicated in hypertension/preeclampsia (risks hypertensive crisis). CHECK BP BEFORE EACH DOSE.
CARBOPROST = contraindicated in asthma (bronchospasm). Side effects common: diarrhea, fever, flushing.
Order of escalation: massage → oxytocin → methylergonovine or carboprost → bimanual compression → balloon tamponade → surgery (curettage, hysterectomy).
All uterotonics cause sustained ('tetanic') uterine contraction — monitor for abdominal pain.
Ergot alkaloids cause vasoconstriction — avoid in cardiac disease.

Key Definitions

Term

Bimanual Compression

Example

Excessive bleeding persists despite oxytocin — perform bimanual compression while summoning help.

Definition

Manual technique: one hand in vagina massages fundus, other hand on abdomen stabilizes; used if drugs fail.

Term

Uterine Balloon Tamponade

Example

Atony uncontrolled by oxytocin/ergot — insert balloon (Bakri, Foley) and inflate to compress bleeding vessels.

Definition

Balloon catheter inserted into uterus and filled with fluid to apply pressure; stops bleeding mechanically.

Diagrams To Know

Uterotonic selection flowchart: Is BP elevated? NO → oxytocin or methylergonovine. YES → oxytocin only. Does patient have asthma? YES → avoid carboprost.

Formulas

Formula

Puerperal Infection Diagnosis: Temperature ≥38°C (100.4°F) on ANY 2 of the FIRST 10 postpartum days (EXCLUDING day 1)

Meaning

Fever ≥38°C on days 2–10; two separate febrile episodes confirm diagnosis.

Watch Out

Day 1 fever is usually from anesthesia or dehydration, not infection — do NOT count it. Start counting from day 2.

When To Use

Any postpartum fever workup.

Common Values

Value

≥38°C (100.4°F)

Symbol

—

Quantity

Fever threshold for puerperal infection

Value

Any 2 days within first 10 postpartum days (excluding day 1)

Symbol

—

Quantity

Fever timing for diagnosis

Section Title

PUERPERAL (POSTPARTUM) INFECTION

Important Facts

RISK FACTORS: Cesarean birth (biggest risk), prolonged rupture of membranes (PROM), prolonged labor, multiple vaginal exams, retained placental fragments, hemorrhage.
SIGNS: Fever, chills, uterine tenderness (REBOUND pain), foul-smelling or profuse lochia, tachycardia, malaise, subinvolution.
ORGANISM most common: polymicrobial (normal vaginal flora ascending). Gram-negatives, anaerobes, Group B Strep common.
MANAGEMENT: Obtain cultures BEFORE antibiotics. Give BROAD-SPECTRUM IV antibiotics (common: clindamycin + gentamicin). Daily labs for WBC trend.
NURSING: Position in SEMI-FOWLER (facilitates lochia drainage toward vagina by gravity). Teach perineal hygiene (FRONT-TO-BACK wiping), frequent pad changes, handwashing.
MONITOR: Lochia character (foul smell is red flag), fundal tenderness, fever curve, WBC count, vital signs for sepsis progression (hypotension, altered mental status).
Continue antibiotics FULL COURSE as prescribed, even if symptoms improve.

Key Definitions

Term

Endometritis

Example

Day 3 postpartum: fever 38.5°C, fundus tender, lochia foul-smelling — endometritis suspected; culture and broad-spectrum antibiotics.

Definition

Infection of uterine lining (most common form of puerperal infection); causes fever, uterine tenderness, foul/profuse lochia.

Term

Subinvolution

Example

Day 7 postpartum, fundus still 2 cm above umbilicus; if combined with fever and foul lochia, suggests infected retained placenta.

Definition

Slowed involution; fundus remains enlarged and boggy. Can be complication of infection or retained tissue.

Diagrams To Know

Endometritis sign progression: fever → chills → fundal tenderness (REBOUND) → foul lochia → if untreated → sepsis (hypotension, confusion).
Lochia normal vs. abnormal: Normal = progresses rubra→serosa→alba, no odor. Abnormal = foul smell, excessive amount, return to rubra.

Common Values

Value

2–4 weeks postpartum

Symbol

—

Quantity

Typical postpartum onset of mastitis

Section Title

MASTITIS

Important Facts

TIMING: Usually 2–4 weeks postpartum (lactation phase).
ORGANISM: Staphylococcus aureus (#1 cause), entered through cracked/fissured nipple; MRSA possible (use vancomycin/clindamycin if resistant).
RISK FACTORS: Poor latch, engorgement, missed feedings, tight bras, inadequate nipple care (no cleansing, moisturizing).
SIGNS: UNILATERAL redness, warmth, hardness, tenderness in WEDGE-SHAPED area of breast. Flu-like symptoms: fever, chills, body aches, malaise.
MANAGEMENT: CONTINUE BREASTFEEDING or PUMPING — emptying the breast is therapeutic. Milk from affected side is SAFE for infant (bacteria killed by gastric acid).
ANTIBIOTICS: Dicloxacillin or cephalexin (first-line anti-staph). Clindamycin or vancomycin for MRSA. Full 10–14 day course.
COMFORT: Warm compresses before feeding (aids milk flow), cold compresses after feeding (reduces inflammation). Analgesics (ibuprofen, acetaminophen safe in lactation). Rest, hydration.
PREVENTION: Proper latch and positioning (rotate starting breast), frequent emptying, avoid tight bras, nipple care (gentle cleansing, lanolin or hydrogel pads to prevent cracking).

Key Definitions

Term

Mastitis

Example

Day 14 postpartum: left breast red, warm, hard, tender, wedge-shaped area; fever 38.8°C, body aches; mastitis diagnosed.

Definition

Inflammation/infection of breast tissue in a lactating mother; usually UNILATERAL, from Staphylococcus aureus via cracked/fissured nipple.

Term

Milk Stasis

Example

Mother skips feedings due to pain or fatigue; milk backs up → breast becomes engorged, warm, tender → portal for S. aureus.

Definition

Accumulation of milk due to missed feedings, poor latch, or engorgement; predisposes to mastitis (milk is ideal medium for bacteria).

Diagrams To Know

Mastitis pathway: Cracked nipple → S. aureus entry → milk stasis (poor emptying) → inflammation/abscess → fever + wedge area of redness/warmth/tenderness.

Common Values

Value

1.5–2.5× control (or per protocol)

Symbol

—

Quantity

aPTT target for heparin therapy

Value

2–3

Symbol

—

Quantity

INR target for warfarin therapy

Section Title

THROMBOEMBOLIC DISORDERS (DVT & PE)

Important Facts

RISK FACTORS: Cesarean birth, obesity, immobility, varicosities, advanced maternal age (>35), prior thrombosis, thrombophilia, prolonged labor, infection.
VIRCHOW'S TRIAD (all present in postpartum): Hypercoagulability (elevated clotting factors), venous stasis (immobility, uterine compression), endothelial injury (delivery trauma).
DVT SIGNS: Unilateral leg pain, warmth, redness, EDEMA, leg tense. HOMANS SIGN (calf pain on dorsiflexion) — UNRELIABLE, no longer emphasized.
PE SIGNS: SUDDEN dyspnea, pleuritic chest pain (worse on breathing), tachypnea (RR >20), tachycardia, apprehension, syncope, hemoptysis (if infarction).
MANAGEMENT DVT: BED REST with leg ELEVATED. WARM MOIST COMPRESSES for comfort. DO NOT MASSAGE THE LEG (risk of clot dislodgement and embolism).
ANTICOAGULATION: Heparin (IV, SC) or LOW-MOLECULAR-WEIGHT HEPARIN (LMWH, e.g., enoxaparin SC) are FIRST-LINE (do not cross placenta, safe in lactation). Warfarin is teratogenic (AVOID antepartum), acceptable postpartum/lactation.
MONITORING: aPTT for heparin (target 1.5–2.5× control). INR for warfarin (target 2–3). Platelet count for heparin-induced thrombocytopenia (HIT).
ANTIDOTES: Protamine sulfate (heparin antidote), Vitamin K (warfarin antidote).
PREVENTION: Early ambulation, leg exercises (ankle pumps, quadriceps sets), adequate hydration, compression devices (TED hose, sequential compression devices) for high-risk women.

Key Definitions

Term

Deep Vein Thrombosis (DVT)

Example

Day 3 postpartum after cesarean: left leg swollen, warm, red, painful — DVT suspected; no calf massage; elevate, anticoagulate.

Definition

Blood clot in deep leg vein; presents with unilateral leg pain, warmth, redness, swelling (edema), tense leg.

Term

Pulmonary Embolism (PE)

Example

Day 5 postpartum, woman suddenly gasps, complains of chest pain, HR 130, RR 28, O₂ sat drops — PE suspected; oxygen, anticoagulation, ICU.

Definition

Clot lodge in pulmonary artery; MEDICAL EMERGENCY. Sudden dyspnea, pleuritic chest pain, tachypnea, tachycardia, apprehension, possibly hemoptysis.

Term

Hypercoagulability

Example

Pregnancy increases Factor V, VIII, X, XII; stasis from uterine compression; vessel injury from delivery → thrombus risk.

Definition

Pregnancy/postpartum state of elevated clotting factors, venous stasis, and vessel injury (Virchow's triad) — thrombosis risk.

Diagrams To Know

PE vs. DVT: DVT localized (leg pain, swelling, redness). PE systemic (dyspnea, chest pain, shock) — more dangerous.
Virchow's triad in postpartum: (1) Hypercoagulability = ↑ clotting factors, ↓ fibrinolysis. (2) Venous stasis = immobility, uterine compression of iliac veins. (3) Endothelial injury = delivery trauma.

Common Values

Value

Within days, resolves by ~2 weeks

Symbol

—

Quantity

Baby blues onset and duration

Value

Within first year postpartum (usually weeks–months)

Symbol

—

Quantity

PPD onset window

Value

Within 1–2 weeks; ~0.1–0.2% of births

Symbol

—

Quantity

PPP onset and prevalence

Value

~10–15% of postpartum women

Symbol

—

Quantity

PPD prevalence

Section Title

POSTPARTUM MOOD DISORDERS

Important Facts

PREVALENCE: Baby blues ~80% of mothers (mild, self-limited). PPD ~10–15% (persistent, needs treatment). PPP ~0.1–0.2% (rare but severe).
BABY BLUES timing: Onset within DAYS, resolves within ~2 WEEKS. Reassurance, rest, support sufficient.
PPD timing: Onset within WEEKS TO MONTHS (first year). Does NOT resolve on its own without treatment.
PPP timing: Onset within FIRST 1–2 WEEKS (acute). Medical emergency.
PPD RISK FACTORS: Prior depression/anxiety, hormonal shifts, sleep deprivation, lack of partner/family support, difficult birth, ill/premature newborn, multiparity, marital conflict.
PPD SYMPTOMS: Persistent sadness, hopelessness, guilt ('bad mother'), fatigue, insomnia/hypersomnia, appetite changes, poor concentration, anhedonia (loss of pleasure), thoughts of self-harm or infanticide.
PPP SYMPTOMS: Delusions (false beliefs, e.g., baby is 'the devil'), hallucinations (usually auditory, command hallucinations common), paranoia, disorganized speech, confusion, agitation, inability to care for self/infant.
SCREENING: Use EDINBURGH POSTNATAL DEPRESSION SCALE (EPDS) at 4–6 weeks postpartum. Screen ALL mothers.
PPD MANAGEMENT: Psychotherapy (cognitive-behavioral, interpersonal). Antidepressants — SSRIs preferred in lactation (sertraline, paroxetine low transfer to milk). Assess for suicidal/infanticidal ideation at each visit.
PPP MANAGEMENT: PSYCHIATRIC HOSPITALIZATION REQUIRED. Antipsychotics (haloperidol, risperidone) + mood stabilizers (lithium, valproate). NEVER leave mother alone with infant — risk of infanticide.

Key Definitions

Term

Postpartum (Baby) Blues

Example

Day 3 postpartum: mother tearful, irritable, anxious, but caring for baby, eating, sleeping normally. Resolves by day 10 with reassurance.

Definition

Mild, transient mood disturbance (tearfulness, anxiety, irritability) within days of birth, resolving within ~2 weeks. Mother REMAINS IN TOUCH WITH REALITY.

Term

Postpartum Depression (PPD)

Example

Week 4 postpartum: mother feels hopeless, unable to enjoy baby, poor sleep despite opportunity, thoughts of 'my baby would be better off without me' — PPD diagnosed; SSRI + therapy started.

Definition

Major depressive episode within first year postpartum. Persistent (weeks–months) sadness, hopelessness, guilt, fatigue, sleep/appetite disturbance, poor concentration, loss of interest in activities or infant. REQUIRES TREATMENT.

Term

Postpartum Psychosis (PPP)

Example

Day 7 postpartum: mother confused, hearing voices commanding her to harm baby, paranoid thoughts about husband. Admitted to psychiatric ICU; antipsychotic + mood stabilizer started.

Definition

PSYCHIATRIC EMERGENCY. Delusions, hallucinations, disorganized thinking, BREAK FROM REALITY. Often COMMAND HALLUCINATIONS to harm infant. Onset within 1–2 weeks. Strongly associated with bipolar disorder.

Diagrams To Know

Mood disorder timeline & severity: Baby blues (days, mild, self-resolves) → PPD (weeks–months, moderate–severe, needs Rx) → PPP (1–2 weeks, SEVERE, psychotic, emergency).

Common Values

Value

~1 cm (1 fingerbreadth) per day

Symbol

—

Quantity

Fundal descent rate

Value

Day 10 postpartum

Symbol

—

Quantity

Fundus non-palpable by

Value

Days 1–3

Symbol

—

Quantity

Lochia rubra duration

Value

Days 4–10

Symbol

—

Quantity

Lochia serosa duration

Value

Days 11–42 (up to 6 weeks)

Symbol

—

Quantity

Lochia alba duration

Value

Non-foul (fleshy, metallic OK)

Symbol

—

Quantity

Lochia odor normal

Section Title

NORMAL POSTPARTUM INVOLUTION (Baseline for Recognizing Deviations)

Important Facts

FUNDUS FIRMNESS: Immediately postpartum, fundus is FIRM (well-contracted). If BOGGY or SOFT → uterine atony. Massage firms it.
FUNDUS HEIGHT: Immediately postpartum, fundus at or just BELOW umbilicus. Descends ~1 cm/day (1 fingerbreadth/day). Non-palpable by day 10.
FUNDUS POSITION: Should be MIDLINE. If deviated to the side (usually right) → FULL BLADDER displacing it. Empty bladder immediately.
FUNDUS DEVIATION left or down = possible hematoma or mass. Assess.
LOCHIA RUBRA (days 1–3): Dark red color from RBCs, fresh blood. Small clots normal (grape-sized or smaller).
LOCHIA SEROSA (days 4–10): Pinkish-brown transition phase. Contains blood, serum, WBCs, endometrial tissue.
LOCHIA ALBA (days 11–42, up to 6 weeks): Yellowish-white from WBCs, tissue. Last stage before cessation.
LOCHIA AMOUNT: Days 1–2 can be heavy (saturating 1 pad/hour normal). By day 3+, should decrease. Heavy or increasing bleeding beyond day 3 = abnormal.
LOCHIA ODOR: Should NOT be foul. Foul smell = infection (endometritis). Foul lochia + fever + fundal tenderness = endometritis.
LOCHIA RETURN TO RUBRA after serosa/alba has begun = ABNORMAL, suggests subinvolution or retained tissue.

Key Definitions

Term

Involution

Example

Fundus firm at umbilicus immediately postpartum, descends to non-palpable by day 10 — normal involution.

Definition

Return of reproductive organs (especially uterus) to non-pregnant state. Fundus descent, lochia progression, cervical closure, return of menstruation.

Term

Lochia

Example

Days 1–3: dark red (lochia rubra). Days 4–10: pinkish-brown (lochia serosa). Days 11–42: yellowish-white (lochia alba).

Definition

Vaginal discharge postpartum; blood, decidua, WBCs. Progresses through three stages: rubra, serosa, alba. NEVER foul-smelling; foul odor = infection.

Diagrams To Know

Normal fundal descent: Day 0 (at/below umbilicus) → Day 1 (1 cm below) → Day 2 (2 cm below) → ... → Day 10 (non-palpable in abdomen).
Normal lochia progression: Rubra (dark red, clots OK) → Serosa (pink-brown) → Alba (yellowish-white). NO foul odor at any stage.

Must Remember

Item

PPH DIAGNOSIS: >500 mL (vaginal) OR >1,000 mL (cesarean) OR hemodynamic instability. Number-one cause = UTERINE ATONY (boggy fundus). FIRST ACTION = fundal massage (before drugs).

Rank

Item

FUNDUS OFF MIDLINE (deviated, usually right) = FULL BLADDER. Empty immediately; bladder prevents contraction. Do NOT assume atony without checking.

Rank

Item

BRIGHT-RED, STEADY BLEEDING with FIRM FUNDUS = TRAUMA (lacerations/hematoma), NOT atony. Look for cervical/vaginal tears or hematoma; may require surgical repair.

Rank

Item

METHYLERGONOVINE (0.2 mg IM) CONTRAINDICATED IN HYPERTENSION/PREECLAMPSIA — raises BP dangerously. ALWAYS CHECK BP BEFORE DOSE. Oxytocin is safe in hypertension.

Rank

Item

CARBOPROST (250 mcg IM) CONTRAINDICATED IN ASTHMA — causes bronchospasm. Common side effects: diarrhea, fever, flushing.

Rank

Item

PUERPERAL INFECTION = fever ≥38°C on ANY 2 days within FIRST 10 postpartum days (EXCLUDING day 1). Endometritis most common; position in SEMI-FOWLER for lochia drainage. Foul lochia + fever + uterine tenderness = endometritis.

Rank

Item

MASTITIS: Unilateral, wedge-shaped area; fever; Staphylococcus aureus from cracked nipple. KEEP BREASTFEEDING/PUMPING — emptying therapeutic, milk is safe. Antibiotics: dicloxacillin or cephalexin (anti-staph).

Rank

Item

DVT MANAGEMENT: Elevate leg, WARM MOIST COMPRESSES, anticoagulation. DO NOT MASSAGE LEG — risk of embolism. Heparin/enoxaparin first-line (safe in pregnancy/lactation). Monitor aPTT or anti-Xa. Antidote = protamine sulfate.

Rank

Item

PE IS MEDICAL EMERGENCY: Sudden dyspnea, pleuritic chest pain, tachypnea, tachycardia. Give oxygen, anticoagulate, ICU monitoring. Postpartum women hypercoagulable (Virchow's triad: clotting factors ↑, stasis, vessel injury).

Rank

Item

POSTPARTUM PSYCHOSIS = psychiatric emergency. Delusions, hallucinations, COMMAND HALLUCINATIONS to harm infant, break from reality. NEVER LEAVE ALONE WITH BABY. Requires hospitalization, antipsychotics + mood stabilizers. PPD (depression, no psychosis) = needs SSRI + therapy. Baby blues (tearfulness, 2 weeks) = supportive care only.

Rank

Last Minute Tips

Tip

UTEROTONIC CONTRAINDICATIONS ARE BOARD FAVORITES. Methylergonovine = contraindicated in hypertension (check BP first). Carboprost = contraindicated in asthma (bronchospasm). Oxytocin = SAFE in hypertension — it is the backup if BP is elevated.

Tip

DO NOT MASSAGE A DVT LEG. This is a classic 'trick' question. Massage can dislodge clot → PE. Instead: elevate, warm compresses, anticoagulate. Heparin/enoxaparin safe in pregnancy & lactation; warfarin teratogenic (antepartum only).

Tip

MASTITIS = KEEP BREASTFEEDING. Stopping worsens stasis and abscess risk. Milk from infected breast is SAFE (stomach acid kills bacteria). This is tested because students often incorrectly advise stopping nursing.

Tip

POSTPARTUM PSYCHOSIS vs. DEPRESSION vs. BLUES — Know the differences by REALITY CONTACT. Baby blues & PPD = reality intact. PPP = break from reality (delusions, command hallucinations). PPP is an EMERGENCY (infanticide risk); PPD needs SSRI + therapy; blues need reassurance only.

Tip

NORMAL LOCHIA NEVER SMELLS FOUL. Foul odor = infection (endometritis). Normal progression: rubra (days 1–3, dark red) → serosa (days 4–10, pink-brown) → alba (days 11–42, yellowish-white). Return to bright-red after serosa = abnormal (retained tissue or subinvolution).

Comparison Tables

Rows

Values

Within FIRST 24 hours
24 hours to 6–12 weeks

Property

Timing

Values

Uterine atony (boggy fundus)
Retained placental fragments or subinvolution

Property

Most Common Cause

Values

Heavy lochia immediately after birth; boggy fundus
Return of bright-red lochia or increased bleeding weeks postpartum

Property

Clinical Presentation

Values

>500 mL vaginal OR >1,000 mL cesarean
Same thresholds apply

Property

Diagnosis Threshold

Values

Fundal massage, empty bladder, oxytocin
Curettage to remove retained tissue; antibiotics if infection

Property

Primary Intervention

Columns

Feature
Early PPH
Late PPH

Table Title

Postpartum Hemorrhage: Early (Primary) vs. Late (Secondary)

Rows

Values

Within DAYS
Within WEEKS–MONTHS
Within 1–2 WEEKS

Property

Onset

Values

~2 WEEKS (self-limited)
WEEKS–MONTHS (persistent, needs Rx)
Variable if untreated (dangerous)

Property

Duration (Untreated)

Values

MILD
MODERATE–SEVERE
SEVERE (EMERGENCY)

Property

Severity

Values

INTACT — mother knows baby is real, cares for baby
INTACT — mother knows reality but feels hopeless/guilty about it
BROKEN — delusions, hallucinations, command voices to harm infant

Property

Reality Contact

Values

Tearfulness, anxiety, irritability, mood swings
Persistent sadness, hopelessness, guilt, sleep/appetite change, poor concentration, anhedonia, suicidal/infanticidal thoughts
Delusions, hallucinations (usually auditory), paranoia, disorganized thinking, confusion, agitation

Property

Key Symptoms

Values

REASSURANCE, rest, support. Self-resolves.
Psychotherapy + SSRIs (sertraline preferred in lactation). Assess for self-harm/infanticide.
PSYCHIATRIC HOSPITALIZATION. Antipsychotics + mood stabilizers. NEVER leave alone with infant.

Property

Treatment

Values

Transient, supportive care only
Requires pharmacologic + psychologic intervention
Medical emergency; risk of infanticide; hospitalize

Property

NLE Tip

Columns

Feature
Baby Blues
Postpartum Depression
Postpartum Psychosis

Table Title

Postpartum Mood Disorders: Baby Blues vs. PPD vs. PPP

Rows

Values

10–40 units/L IV infusion OR 10 units IM
YES — First-line
None (safe in hypertension)
Water intoxication risk if large IV volumes; never push as IV bolus

Property

Oxytocin

Values

0.2 mg IM (may repeat)
NO — Second-line
HYPERTENSION/PREECLAMPSIA (raises BP dangerously)
CHECK BP BEFORE EACH DOSE. Sustained contraction may cause uterine tetany (pain)

Property

Methylergonovine

Values

250 mcg IM q15–90 min (max 8 doses)
NO — Third-line
ASTHMA (bronchospasm)
Diarrhea, fever, flushing, shivering. More side effects than others

Property

Carboprost

Values

600–1,000 mcg rectally/orally
NO — Adjunct/resource-limited settings
None (well-tolerated)
Fever/shivering. No cold chain needed; useful in low-resource areas. Less potent than IV oxytocin

Property

Misoprostol

Columns

Drug
Dose
FIRST-LINE? (Y/N)
Contraindication
Key Side Effect/Note

Table Title

Uterotonic Drugs: Choice by Scenario

Rows

Values

IV, SC
aPTT (target 1.5–2.5× control)
YES
YES
Protamine sulfate

Property

Heparin (unfractionated)

Values

SC
Anti-Xa level (if renal impairment)
YES
YES
Protamine sulfate (partial reversal)

Property

LMWH (e.g., enoxaparin)

Values

PO
INR (target 2–3)
NO — Teratogenic (embryopathy, fetal bleeding)
YES
Vitamin K (phytonadione)

Property

Warfarin

Values

First-line for DVT/PE in postpartum (no placental crossing)
Preferred in many postpartum protocols (longer half-life, SC dosing)
AVOID antepartum; OK postpartum/lactation
—

Property

NLE Context

Columns

Anticoagulant
Route
Monitoring
Safe in Pregnancy?
Safe in Lactation?
Antidote

Table Title

Anticoagulant Choice: DVT/PE Management in Postpartum

Rows

Values

2–4 weeks postpartum
Days 3–5 postpartum
Variable (any time during lactation)

Property

Onset

Values

UNILATERAL, WEDGE-SHAPED
BILATERAL, diffuse
Localized lump/area

Property

Affected Area

Values

Red, warm, edematous
Shiny, tight, red (milder)
Normal or slightly red

Property

Skin Appearance

Values

Fever, chills, body aches, malaise
Usually none (afebrile)
Usually none (afebrile)

Property

Systemic Symptoms

Values

Bacterial infection (S. aureus) from cracked nipple
Milk accumulation from engorgement (not infection)
Milk duct obstruction (retained milk)

Property

Cause

Values

CONTINUE breastfeeding, antibiotics (dicloxacillin), warm compresses, rest
Frequent emptying, cold compresses, analgesics, proper latch
Frequent emptying, warm compresses, gentle massage, position changes

Property

Management

Values

Fever + unilateral wedge = mastitis. Key: KEEP BREASTFEEDING.
Afebrile, bilateral, days 3–5 = engorgement (not infection)
Afebrile, localized lump = suspect duct occlusion; massage, feed frequently

Property

NLE Tip

Columns

Feature
Mastitis
Engorgement
Plugged Duct

Table Title

Mastitis vs. Breast Engorgement vs. Plugged Duct

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Complications of Labor & Delivery

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