title: [Maternal care after vaginal delivery and management of complications in immediate post-partum--Guidelines for clinical practice].
abstract: OBJECTIVE
  To provide recommendations on maternal care after vaginal delivery, and management of complications in immediate post-partum period.
  
  
  METHODS
  Bibliographic research from the Pubmed database and recommendations issued by the main scientific societies, and assignment of a level of evidence and a recommendation grade.
  
  
  RESULTS
  After a vaginal delivery, monitoring of blood pressure, heart rate, bleeding, uterine involution, genital pain, urination, temperature, transit and signs of phlebitis is recommended (professional consensus). Post-partum Anemia is defined by a hemoglobin<11 g/dL at 48 hours (grade C). Anemia must be searched only in women who have bled during delivery or who present symptoms of anemia (professional consensus). Oral iron supplementation is only proposed in cases of biologically proven anemia (professional consensus). In case of post-partum hypertension or de novo preeclampsia, the prescription rules for antihypertensive treatments and magnesium sulfate are the same as in prenatal period (professional consensus). Oral NSAIDs are effective for perineal pain and uterine involution (EL2). In case of broken down perineal wounds following childbirth, there is no argument in favor of suturing or not suturing, however the suturing is to be preferred for large dehisced perineal wounds (professional consensus). Infection of perineal scar justifies an oral broad-spectrum antibiotics, in addition to local nursing (professional consensus). In case of obstetric anal sphincter injuries, an antibiotic prophylaxis is recommended (grade B). Hygiene advice should be given to all women who had an episiotomy or a perineal tear (professional consensus). The only etiological treatment of post-dural puncture headache is the blood patch (EL2). It must not be carried out before 48 hours (professional consensus). Thromboembolic risk after a vaginal birth is about 1‰ (EL2). The prescription of thromboprophylaxis with LMWH and graduated compression stockings should be based on risk factors (professional consensus).
  
  
  CONCLUSIONS
  During the immediate post-partum period, complications may be unrecognized or confused with the natural post-partum evolution, which implies a strong vigilance from practitioners. This vigilance is all the more necessary that the maternal residence durations are shortened.
authors.affiliation: Service de gynécologie obstétrique, médecine fœtale, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR Inserm U930, université François-Rabelais de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France. Electronic address: emmanuel.simon@univ-tours.fr.
authors.forename: E-G
authors.initials: EG
authors.lastname: Simon
authors.affiliation: Pôle d'anesthésie réanimation SAMU, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Laffon
mesh_terms: D032921:Consensus; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000628:therapy*; D011181:Postnatal Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D049590:Postpartum Period; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology / Q000628:therapy*; D014621:Vagina
keywords: Accouchement voie basse; Anesthésie périmédullaire; Epidural analgesia; Hemorrhage; Hémorragie; Infection; Post-partum; Vaginal delivery