Postpartum Physical Assessment

Parameters
Vital Signs
Blood Pressure

Normal Findings

Should remain consistent with baseline

BP during pregnancy

Alterations/Possible
Causes

Pulse

50-90 beats/min
May be bradycardia of 50-70
beats/minute

Tachycardia (difficult labor

and birth, hemorrhage)

Respirations

16-24/minute

Marked tachypnea
(respiratory disease)

Temperature

89-100.4*F (36.2-38*C)

After first 24 hours

temperature of 100.4*F or
above suggests infection
(elevated temp during first 24
hours suggests dehydration)

Pain

Subjective; depends on origin

Afterpains caused by intermittent
uterine contractions
Afterpains occur more commonly in
multiparas, multiple pregnancies,
hydramnios, breastfeeders, and
following administration of oxytocic
agents (ie. Methergine, Pitocin)
Cause discomfort for 2-3 days
following birth
Normal S1/S2 without
murmurs/gallops/or rubs

May occur if clots or

placental fragments were
retained

Enlargement, thrills, thrusts,

gross irregularity or skipped
beats, gallop rhythm or extra
sounds (cardiac disease)

Heart

High BP (PIH, essential

hypertension, renal disease,
anxiety)
Drop in BP (may be normal;
uterine hemorrhage)

Actual Findings
(flag abnormals)

Parameters

Normal Findings

Alterations/Possible
Causes

Lungs

Clear to auscultation without

adventitious sounds

Breasts

General appearance: Smooth, even

pigmentation, changes of pregnancy
still apparent; one may appear larger
Palpation: Depending on postpartal
day, may be soft, filling, full, or
engorged
Nipples: Supple, pigmented, intact;
become erect when stimulated
Wearing support bra

Musculature: Abdomen may be soft,

have a doughy texture; rectus muscle
intact
Fundus: Firm, midline; following
expected process of involution (?
Fingerbreadths below the umbilicus)
May be slightly tender when palpated

Abdomen

Skin Changes of Pregnancy

Darkening of nipple and areola,

especially in primips and dark-haired
individuals.
Linea nigra- dark pigmented line in
midline of abdomen
Striae (stretch marks)- reddish
irregular, wavy depressed streaks over
abdomen and buttocks- fade to silver
streaks
Facial chloasma- mask of pregnancy.
Darkening of skin on forehead, around
eyes. Fades after pregnancy

Rales, rhonchi, wheezes;

pleural friction rub; absence
of breath sounds
Reddened area (mastitis)
Palpable mass (caked breast,
mastitis)
Engorgement (venous stasis)
Tenderness, heat, edema
(engorgement, caked breast,
mastitis)
Fissures, cracks, soreness
(problems with
breastfeeding), not erectile
with stimulation (inverted
nipples)
Separation in musculature
(diastasis recti abdominis)

Boggy fundus (full bladder,

uterine bleeding)

Constant tenderness
(infection)

Actual Findings
(flag abnormals)

Parameters

Normal Findings

Costo-Vertebral Angle (CVA)

Tenderness
Elimination
Bowel

Telangiectasis- vascular spiders- red

slightly raised- occur on neck, thorax,
face, and arms
None
Bowel sounds present in all quads
Should have normal bowel movement
by 2nd or 3rd day after birth

Alterations/Possible
Causes

Bladder

Perspiration

Episiotomy/Laceration/Incision
(circle which is applicable)

Voiding in sufficient quantities at least

every 4-6 hours without discomfort
Bladder not palpable
Elimination of excess fluid and waste
products via the skin

Absence of bowel sounds

Inability to pass feces
(constipation due to fear of
pain from episiotomy,
hemorrhoids, peri trauma)

Inability to void (urinary

retention)
Symptoms of urgency,
frequency, dysuria (UTI)

Occurs frequently at night

REEDA: No redness, edema,
ecchymosis, or discharge; edges well
approximated
Hemorrhoids: None present; if present,
should be small and nontender

Lochia

Present (kidney infection)

Scant to moderate amount, earthy odor;

no clots
Normal progression:
First 1-3 days: rubra (red)
Days 3-10: serosa (pink)
Days 10 to 3 weeks: alba (creamy
white)

Marked fullness, bruising,

pain (vulvar hematoma)
Redness, edema, ecchymosis,
discharge, or gaping stitches
(infection)
Full, tender, inflamed
hemorrhoids
Large amount, clots
(hemorrhage)
Foul-smelling lochia
(infection)
Failure to progress normally
or return to rubra from serosa

Actual Findings
(flag abnormals)

Parameters

Normal Findings

Alterations/Possible
Causes

No pain with palpation; negative

Homans sign

Edema

Slight amount of dependent edema

DTRs

2+ without clonus
Assistance when OOB first time, then
prn
Ambulation ad lib with one or two daily
naps (cesarean moms progress as
tolerated with early ambulation
encouraged)
Rest periods prn
Postpartal exercises
Regular diet
o Nonnursing= return to
prepregnancy levels (ie. reduce
RDA by 300 kcal)
o Nursing=increase caloric intake by
200 kcal over pregnancy
requirements (ie. 500 kcal increase
from prepregnancy requirement)
resulting in a total of about 25002700 kcal/day
Fluid > 2000 mL/day
Approximately 10-12 lb, initially
Additional weight loss will be most
rapid during the first few weeks after
birth
Return to postpartum weight varies
from 6 weeks to 6 months (dependent
upon amount of weight gained and
other factors, such as breastfeeding)

Lower Extremities
Homans sign

Activity

Diet

Weight Loss Since Delivery

(subinvolution)
Positive findings
(thrombophlebitis)
Pitting edema of face, hands,
legs, abdomen, sacral area
(PIH)
Hyperactivity, clonus (PIH)

< 10 lb initially (PIH, fluid

retention)

Actual Findings
(flag abnormals)

Norms and alterations derived from: Davidson, M.R., London, M., & Ladewig, P.W. (2012). Olds maternal-newborn nursing & womens health care (9th
ed.). Upper Saddle River, NJ: Prentice-Hall, Inc.