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Referral and warning signs
When to refer
Refer mother or baby if danger signs or significant complications detected.
Red flags
- Maternal: Heavy/foul bleeding, High fever, Severe pain, Resp distress/chest pain, Leg swelling/pain, Severe headache/visual changes, Suicidal thoughts.
- Neonatal: Any danger sign (See PED002), Poor feeding/weight loss, Significant jaundice, Temp instability, Lethargy.
Signs and symptoms
- Focus is on monitoring for normal recovery and detecting problems.
- Maternal Assessment Areas: General well-being, mood, vital signs, uterine involution, lochia, perineal healing, breast health, bladder/bowel function, anaemia signs, infection/thrombosis signs.
- Newborn Assessment Areas: Feeding, weight, jaundice, cord stump, activity, breathing, temperature, elimination, infection/danger signs.
Risk factors
- Pregnancy/delivery complications.
- Pre-existing maternal conditions.
- Neonatal issues.
- Lack of social support.
- Previous mental health issues.
Diagnosis
Clinical assessment
Routine scheduled assessments (e.g., discharge, 6 days, 6 weeks). History (maternal/baby well-being, feeding, bleeding, pain, mood). Physical examination.
Investigations
- Hb check (mother) if indicated.
- Postnatal depression screening.
- Newborn check.
- Infant HIV testing if exposed.
Diagnostic criteria
Routine assessment against postpartum/neonatal norms.
Management
Non-pharmacological management
- Counseling/Support: Breastfeeding, Maternal nutrition/hydration, Hygiene, Rest/activity, Pelvic floor exercises, Infant care (warmth, hygiene, cord, danger signs), Family planning, STI/HIV prevention, Psychosocial support/depression screening, Partner involvement, Resuming sex.
- Assessment/Management: Perineal pain, Breast engorgement/sore nipples, Uterine involution, Lochia assessment, BP monitoring, Anaemia management.
Pharmacological treatment
- Continue Iron/Folic Acid (mother, 3-6m PP).
- Analgesia (Paracetamol).
- Treat complications (infection, hypertension etc).
- Provide chosen family planning method.
Monitoring
Scheduled visits (6d, 6w). Monitor maternal recovery, infant growth/feeding/well-being. Ensure linkage to ongoing care.
Complications
- Maternal: Secondary PPH, Sepsis, Wound infection, Mastitis, UTI, Thromboembolism, Postnatal depression/psychosis, Anaemia.
- Neonatal: Poor weight gain, Feeding difficulties, Jaundice, Sepsis, Dehydration.
Prevention
- Good ANC/Intrapartum care.
- Early breastfeeding.
- Hygiene.
- Early detection/management of problems.
- Family planning.
Patient education
- Normal recovery.
- Self-care.
- Breast care/feeding.
- Infant care.
- Recognizing danger signs (mother/baby).
- PNC check-ups.
- Family planning.
- Mental health.
Uganda-specific notes
PNC attendance often low. Integrate with immunization visits. Focus on danger signs, BF, FP, hygiene, ITNs.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 16, Section 16.6.1 (including 16.6.1.1, 16.6.1.2)