What is the purpose and typical schedule of the first postpartum (after delivery) checkup?

First Postpartum Check: Purpose and Schedule

The first postpartum checkup should occur within 3-10 days after delivery (ideally within 72 hours for high-risk individuals), followed by a comprehensive visit at 4-6 weeks postpartum, to monitor maternal physical and psychological recovery, manage complications, and provide preventive care. 1, 2

Recommended Timing of Postpartum Visits

• Early postpartum visit (3-10 days after delivery) focuses primarily on blood pressure management and medication titration, especially for those with hypertensive disorders of pregnancy 1
• Comprehensive postpartum visit should occur between 4-6 weeks after delivery to assess overall maternal recovery and address ongoing health needs 1, 2
• For women with gestational diabetes, glucose tolerance testing should be performed 6-12 weeks postpartum using a 75-g oral glucose tolerance test 1
• Women with hypertensive disorders of pregnancy should have a blood pressure check within 7 days of delivery 2

Key Components of the Postpartum Visit

Physical Health Assessment

• Blood pressure measurement to identify persistent hypertension or new-onset hypertension 1
• Weight and waist circumference measurement to establish baseline for postpartum weight management 1
• Assessment of postpartum bleeding patterns (normal bleeding typically lasts up to 6 weeks with gradual decrease in volume) 3
• Evaluation of cesarean or vaginal delivery site healing 4
• Screening for urinary or fecal incontinence that may require pelvic floor rehabilitation 4
• Assessment for breastfeeding challenges and provision of lactation support 2, 4

Laboratory and Diagnostic Testing

• Complete blood count if indicated by symptoms of anemia or significant blood loss during delivery 4
• 75-g oral glucose tolerance test for women with gestational diabetes (between 4-12 weeks postpartum) 1
• Lipid profile after 12 weeks postpartum if not performed in the year prior to pregnancy 1
• Additional labs to consider: high-sensitivity CRP, lipoprotein(a), creatinine, and urinalysis microalbumin/creatinine ratio for women with hypertensive disorders 1

Mental Health Screening

• Comprehensive biopsychosocial assessment including screening for postpartum depression using validated tools like PHQ-9 1, 2
• Screening for anxiety using tools such as GAD-7 1
• Assessment for postpartum post-traumatic stress disorder, particularly after difficult deliveries 1

Preventive Care

• Discussion and provision of contraception options based on breastfeeding status and medical history 1, 2
• Long-acting reversible contraceptives are strongly recommended for appropriate candidates due to their <1% failure rate and safety in patients with hypertension 1
• Combined hormonal contraceptives should be avoided in women with uncontrolled hypertension (BP >160/110 mmHg) 1
• Vaccination status assessment and updates as needed 4
• Counseling on interpregnancy spacing and future pregnancy planning 1

Chronic Disease Management

• For women with gestational diabetes, initiation of strategies for primary prevention of type 2 diabetes 1
• For women with hypertensive disorders of pregnancy, assessment of cardiovascular risk factors and appropriate follow-up 1
• Transition to primary care for ongoing management of chronic conditions identified during pregnancy 1

Special Considerations for High-Risk Groups

Women with Hypertensive Disorders of Pregnancy

• Blood pressure monitoring should occur within 72 hours after discharge 1
• Home blood pressure monitoring programs with daily or twice daily checks in the first week after discharge are recommended 1
• Early postpartum visits should focus on medication titration and symptom monitoring 1
• Long-term follow-up is essential as these women have increased lifetime risk of cardiovascular disease 1

Women with Gestational Diabetes

• 35-60% of women with gestational diabetes develop type 2 diabetes within 10 years 1
• After initial postpartum testing at 6-12 weeks, glucose tolerance testing should be repeated at 1 year and at minimum every 3 years thereafter 1
• Fasting plasma glucose alone is insufficient to detect impaired glucose tolerance and diabetes 1

Barriers to Postpartum Care

• While overall prevalence of postpartum visits is high (89%), rates are significantly lower in certain populations (71% among women with ≤8 years of education and 66% among women without prenatal care) 5
• Telehealth visits can improve access for patients facing barriers such as transportation limitations, geographic distance, or limited childcare 1
• Home visits may be more convenient and reduce the need for emergency department visits 1

Complications to Monitor During Postpartum Period

• Persistent postpartum bleeding beyond expected patterns may indicate complications such as retained products of conception or infection 3, 6
• Secondary postpartum hemorrhage can occur between 24 hours and 6 weeks postpartum 3
• Endometritis, urinary incontinence, and thyroid disorders are common medical complications during the postpartum period 2, 7
• Thrombotic complications such as deep vein thrombosis or ovarian vein thrombophlebitis require prompt diagnosis and treatment 6

The postpartum period represents a critical opportunity to address both acute recovery needs and establish care plans for long-term health, particularly for women with pregnancy complications that increase future health risks 2.