1. Killion, Molly M. MS, RN, CNS

Article Content

Maternal morbidity and mortality in the United States is often discussed. Many pregnancy-related deaths occur during postpartum. Approximately 17% of deaths occur in the first 24 hours postpartum and 40% in the 6 weeks that follow (Green et al., 2021). However, there is minimal research on normal postpartum vital sign ranges. Most of the thresholds for maternal early warning signs algorithms are based on expert opinion of normal vital sign ranges and vary widely between algorithms and countries (Green et al.).


A recent study from the United Kingdom followed 900 women for 2 weeks postpartum to create evidence-based day-specific vital sign centiles. Green et al. (2021) noted the following: blood pressure rose for almost a week after birth and women in the 3rd centile never went below a diastolic BP of 97 mm Hg (higher than the current threshold of 90 mm Hg). The threshold for oxygen saturation of 95% or above as normal was validated as normal during postpartum. They were unable to find a reliable value for heart or respiratory rates. Although these values may not be far from current early warning sign systems, there may be value in changing the values to become more specific across antepartum, intrapartum, and postpartum.


Another study examined women who had experienced severe morbidity during pregnancy or birth from the postpartum period up to 30 years after birth and found that these women also had a higher risk of mortality during postpartum and beyond (Ukah et al., 2021). Mortality risk was highest in the first year for women who had experienced cardiac complications, cerebrovascular accidents, and acute renal failure. These conditions are associated with known conditions that contribute to pregnancy morbidity and mortality. There may be benefit to extending care of women with high-risk conditions in pregnancy to promote lifelong health management instead of limiting the diagnoses of preeclampsia, diabetes, and other complications to being just pregnancy-related.


It is important to note that studies are specific to race and ethnicity of the samples. In the United Kingdom, approximately 86% of the women studied were white, non-Hispanic (Green et al., 2021) and in Quebec, Canada study, race and ethnicity were not reported (Ukah et al., 2021).


The American College of Obstetricians and Gynecologists (ACOG, 2018) recommends women should be seen during postpartum in a tighter timeframe than has been historically practiced and encourages care after birth be considered a continuum instead of a single visit. As pregnancy care is tailored to fit health and education needs of the pregnant woman, postpartum care should do more to help women and their families with long-term health maintenance and promotion. Approximately 40% of women do not access postpartum care, which can cause issues with chronic health conditions and may also prevent access to effective contraception (ACOG). Ideally, there should be a transition to primary care so that patients may continue with health maintenance and management of health conditions long-term.


In many cultures, there is a 30- to 40-day period of rest and assistance for the new family that allows for nutritious food, housekeeping, and parenting assistance (ACOG, 2018). Doing more to mirror that from a health and illness lens could optimize long-term outcomes for all women, especially those who experienced morbidity during their maternity care. Postpartum care warrants a closer look at normal ranges of vital signs for all women of all races and ethnicities. Tailoring maternal early warning systems to a data-driven set of parameters may yield better detection of women at risk for severe maternal morbidity or mortality during postpartum.




American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care (Committee Opinion No. 736). Obstetrics and Gynecology, 131(5), e140-e150.[Context Link]


Green L. J., Pullon R., Mackillop L. H., Gerry S., Birks J., Salvi D., Davidson S., Loerup L., Tarassenko L., Mossop J., Edwards C., Gauntlett R., Harding K., Chappell L. C., Knight M., Watkinson P. J. (2021). Postpartum-specific vital sign reference ranges. Obstetrics and Gynecology, 137(2), 295-304.[Context Link]


Ukah U. V., Dayan N., Potter B. J., Ayoub A., Auger N. (2021). Severe maternal morbidity and risk of mortality beyond the postpartum period. Obstetrics and Gynecology, 137(2), 277-284.[Context Link]