[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Maternal and child nursing](https://durgical.com/en/nursing/areas/maternal-child/) › The postpartum assessment: uterus, lochia, perineum, breasts, bladder, legs, mood and bonding

# The postpartum assessment: uterus, lochia, perineum, breasts, bladder, legs, mood and bonding

- Assessment

After birth the nurse checks, in order, vital signs, the uterus, bleeding, perineum, breasts, bladder, legs, mood and how mother and baby bond.

Updated Nov 13, 2026

## Key points

- First 2 hours: vital signs and bleeding every 15 minutes, and check that the uterus is contracted (Res. 3280).
- WHO: blood pressure shortly after birth and again within 6 hours; the first void is recorded within 6 hours.
- Postpartum fever is a temperature above 38 °C, except in the first 24 hours (Res. 3280).
- No spontaneous void 6 hours after birth means urinary retention (Res. 3280).
- Mood: ask the two questions of Res. 3280 at each contact (see perinatal mental health).

## What it is

The postpartum assessment finds haemorrhage, infection, hypertension, thrombosis and depression early, and supports breastfeeding and bonding. Res. 3280 de 2018 asks for vital signs and bleeding every 15 minutes in the first 2 hours, then watch of uterine involution, lochia, fever and tachycardia up to 48 hours, using the obstetric early warning scale adapted for Colombia. WHO recommends regular checks of bleeding, uterine contraction, fundal height, temperature and pulse in the first 24 hours. The same order is repeated at each contact, at the bedside and at the visit after discharge.

## Reference values

- Uterus: firm and round, felt near the navel soon after birth; usually hard to feel through the abdomen after about a week (MedlinePlus).
- Lochia: red, then pink, then yellow or white; it can last up to about 6 weeks, and a short increase in red bleeding between days 7 and 14 is common (MedlinePlus).
- Small clots may pass when the woman first gets up or when the uterus is pressed.
- Afterpains while breastfeeding are expected and help the uterus contract.
- Colombia uses an obstetric early warning scale adapted for the country, attached to Res. 3280 (see obstetric early warning scores).

## What you need

- Privacy, a good light and clean gloves.
- Thermometer, blood pressure cuff and the early warning chart.
- A clean pad to judge the amount of lochia.
- The mental health questions and the referral route of the institution.

## How to measure it (and why)

- Explain, ensure privacy and ask her to pass urine first if she can — a full bladder is checked whenever the uterus bleeds and can displace it.
- Take temperature, pulse, pressure and breathing, and score the warning scale — tachycardia and fever can be the first sign of bleeding or infection.
- With her lying down, rest one hand above the pubis and palpate the fundus with the other: is it firm and central? — a soft uterus bleeds.
- Look at the pad and sheets: amount, colour, clots and smell of the lochia — foul lochia suggests infection.
- Inspect the perineum, tear or episiotomy: swelling, bruising, pain and sutures — a growing painful swelling can be a haematoma.
- Examine breasts and nipples and watch a feed: fullness, redness, cracks and latch — this prevents engorgement and mastitis.
- Ask about urine and stools, pain on urination and constipation — retention and urinary infection are common after birth.
- Look at both legs for pain, swelling, redness or warmth on one side, and review her clot risk — postpartum raises that risk.
- Ask about mood, sleep and support with the protocol questions, and watch how she responds to the baby — this finds depression early.
- Record everything and compare with the last check — the trend matters more than one value.

## How to read it

- A uterus above the expected level and pushed to one side suggests a full bladder.
- Heavy bleeding with a firm uterus suggests a tear or haematoma; with a soft uterus, atony.
- Fever, a tender uterus and foul lochia suggest endometritis.
- Headache, blurred vision or epigastric pain after birth may be pre-eclampsia, which can start postpartum.
- Before discharge, give information on gender-based and sexual violence and the ways to report it, as Res. 3280 asks; screening is covered on the gender-violence page.

## Next step: when to call for help

- Call at once for heavy bleeding, a soft uterus that does not firm with massage, or signs of shock.
- Call if there is no spontaneous void 6 hours after birth.
- Call for fever above 38 °C after the first 24 hours, foul lochia or a tender uterus.
- Call for a red, painful or swollen leg, chest pain or breathlessness.
- Call for severe headache, vision changes or high blood pressure.
- Call the same day if she answers yes to the mood questions or has thoughts of harming herself or the baby.

## Test yourself

Think of the answer, then tap the question to see it.

## How often are vital signs and bleeding checked in the first 2 hours after birth?

Every 15 minutes.

## From when does a temperature above 38 °C count as postpartum fever in Res. 3280?

After the first 24 hours following birth.

## What does a fundus above the expected level and pushed to one side suggest?

A full bladder.

## How do lochia change in colour over the weeks after birth?

From red, to pink, to yellow or white.

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## Elsewhere in DurgiPedia

- [Attachment: Bowlby, Ainsworth and the attachment styles](https://durgical.com/en/behavioral-science/attachment-bowlby-ainsworth-and-the-attachment-styles/)

## Connections

## Related 3

- [Labour and postpartum nursing: monitoring and warning signs](https://durgical.com/en/nursing/labour-and-postpartum-nursing-monitoring-and-warning-signs/)
- [Breastfeeding support: latch, positions and common problems](https://durgical.com/en/nursing/breastfeeding-support-latch-positions-and-common-problems/)
- [Mechanical prevention of venous thromboembolism: stockings and intermittent compression](https://durgical.com/en/nursing/mechanical-prevention-of-venous-thromboembolism-stockings-and-intermittent-compr/)

## Related conditions 2

- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Acute mastitis](https://durgical.com/en/conditions/acute-mastitis/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-3280-de-2018.pdf) (Ministerio de Salud y Protección Social de Colombia, 2018); [WHO Labour Care Guide: user's manual (Annex: WHO recommendations on intrapartum care)](https://iris.who.int/server/api/core/bitstreams/94326918-1f91-49a2-a857-12831cd51b91/content) (World Health Organization, 2020); [Vaginal delivery - discharge](https://medlineplus.gov/ency/patientinstructions/000628.htm) (MedlinePlus, U.S. National Library of Medicine, 2025); [After vaginal delivery - in the hospital](https://medlineplus.gov/ency/patientinstructions/000629.htm) (MedlinePlus, U.S. National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/the-postpartum-assessment-uterus-lochia-perineum-breasts-bladder-legs-mood-and-b/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-postpartum-assessment-uterus-lochia-perineum-breasts-bladder-legs-mood-and-b/