Chapter 9: The Puerperium Flashcards
PUERPERIUM. You are a trainee intern in the postnatal ward seeing Frances, a 34 year old Pākehā woman who has a temperature of 38oC. Frances had a Ventouse delivery 36 hours ago for a prolonged second stage of labour. Frances feels flushed and her lochia is slightly smelly. On examination, the uterus is tender and the fundus is at the level of the umbilicus. Which of the following options is the most likely cause of her fever?
Breast engorgement
Urinary tract infection
DVT
Mastitis
Respiratory infection
Genital tract infection
Genital tract infection
PUERPERIUM You are a trainee intern in a general practice seeing Rosemary, a 33 year old Pākehā woman who had her first baby 14 days ago. Rosemary feels unwell and has a temperature of 38OC. She is breastfeeding but is aware of some tenderness in her left breast. On examination, she has an erythematous, non-fluctuant wedge-shaped tender soft area on her left upper and outer breast. Which of the following is the most likely cause of her presenting symptoms and signs?
Mastitis
Breast engorgement
Breast abscess
Impetigo
Breast cancer
Mastitis
You are a trainee intern in a general practice seeing Anita, a 33 year old Indian woman who had her first baby 14 days ago. Anita feels unwell and has a temperature of 38.2OC. She is breastfeeding but is aware of some tenderness in her left breast. On examination, she has an erythematous, non-fluctuant wedge-shaped tender soft area on her left upper and outer breast. Which of the following is the most appropriate treatment?
Incision and drainage of the abscess
Feed or express from right breast only
Breast support and analgesia
Broad spectrum antibiotics including anaerobic cover
Flucloxacillin
Flucloxacillin
You are a trainee intern in the postnatal ward seeing Anahera, a 34 year old wahine Māori who has a temperature of 38.2 oC. Anahera had a Ventouse delivery 36 hours ago for a prolonged second stage of labour. She feels flushed and her lochia is smelly. On examination, the uterus is tender and the fundus is at the level of the umbilicus. Which of the following is the most appropriate treatment?
Conservative / expectant management & paracetamol for the fever
Misoprostol
Flucloxacillin
Ergometrine
Broad spectrum antibiotics including anaerobic cover
Evacuation of the uterus
Broad spectrum antibiotics including anaerobic cover
You are a trainee intern on the post-natal ward seeing Maria, a 37 year old Samoan woman who had her first baby yesterday. Breast feeding is going well so far. Maria asks you how long she should exclusively breast feed her baby for before she introduces solids. Which of the following is correct?
6 months
1 month
2 months
12 months
4 months
9 months
6 months
You are a trainee intern on the birthing suite and have just been involved in Meera’s labour and birth. Meera is a 25 year old New Zealander of Bangladeshi ethnicity who has just had her first baby. She has been told that the breast milk she produces in the first few days of the baby’s life is different to subsequent. You discuss colostrum with her and she asks how its content differs from mature milk. Compared with mature milk, colostrum is
Higher in fat and sodium
Lower in sodium, potassium and chloride
Lower in water-soluble vitamins
Higher in protein, sodium, and fat soluble vitamins
Lower in fat and carotenoids
Higher in protein, sodium, and fat soluble vitamins
You are a trainee intern in General Practice seeing Bai, a 31 year old Chinese woman who had her first baby 10 days ago. Her baby was born as a ventouse birth and Bai had an epidural in labour. Bai has engorged breasts that are extremely painful. She is considering giving up on breastfeeding as she doesn’t think that she can cope with the discomfort. What is severe breast engorgement most likely due to?
Infrequent feedings
You are a trainee intern doing a postnatal ward round seeing Jenny, a 29 year old Pākehā woman who had her first baby 3 days ago via emergency caesarean section for a prolonged labour. She is breast feeding but has sore nipples. The problem began with the first feeding and has persisted with each feeding. What is the most likely cause of the problem?
Poor attachment to the breast
Baby’s suck is too long
Lack of nipple preparation during pregnancy
Inverted nipples
Feeding time is too long
Poor attachment to the breast
You are a trainee intern in a general practice seeing Hana, a 37 year old wahine Māori who has been brought in by her husband Tama. Their baby was born 5 weeks ago. Tama is worried because Hana is tearful and irritable and sleeping poorly. Hana agrees that she is exhausted and her mood is low but blames it on being sleep deprived with breast feeding. Hana feels guilty because she is not enjoying motherhood and is worried she is not doing a good job. Which of the following is the most important to assess for when you see Hana?
Whether Tama is a supportive husband
Suicidality and safety of baby
Symptoms of hypothyroidism such as slow pulse and hoarse voice
How Hana’s appetite is
Whether Hana has early morning waking
Suicidality and safety of baby
You are a trainee intern in general practice seeing Kathryn, a 24 year old primiparous Pākehā woman who presents acutely ten days post-partum, worried about her baby who is crying and fretful. He has not regained his birth weight. On questioning, she is giving her baby boiled water, the weather is hot and her baby seems thirsty. Which of the following is the best advice?
Try using a pacifier (dummy) to settle the baby
Continue breast feeding and add formula top-ups.
Stop breast feeding and use a fortified baby formula instead
Discontinue the water supplement and solely breast feed the baby
Increase the frequency of breastfeeding and continue with the water supplement
Discontinue the water supplement and solely breast feed the baby
You are a trainee intern on the post-natal ward seeing Ngarangi, a 24 year old wahine Māori whose second baby was born yesterday. Ngarangi was diagnosed with post-natal depression after the birth of her first child and required a 2 month inpatient stay on the ‘Mothers & Babies’ psychiatric ward. She was unable to breast feed her first child. Ngarangi has been on 20mg fluoxetine daily through her pregnancy and her mood has been stable. She is worried that she will again develop post-natal depression and she would like to breast feed. She has heard that fluoxetine is passed through into breast milk. What advice do you give Ngarangi?
She should continue on the fluoxetine but as it passes into her breast milk she should formula feed.
She can safely breastfeed on her current fluoxetine dose
As her mood has been stable and fluoxetine passes into breast milk, she should stop the fluoxetine
She should be changed to Lithium while she is breast feeding
As some fluoxetine passes into breast milk, she should halve the dose to 10mg od
She can safely breastfeed on her current fluoxetine dose
You are a trainee intern seeing Shu in general practice. She is a 33 year old New Zealander of Chinese ethnicity whose second baby is 6 weeks old. She is feeling tearful and irritable and doesn’t feel like she is bonding with her baby. She is sleeping poorly but attributes this to her baby waking frequently. Her mood is low and she is anxious her baby is not getting enough breast milk. Shu has poor concentration and reduced appetite. She reports that her husband is supportive and denies any domestic violence. She denies hallucinations. She feels sometimes like she wishes ‘everything would end’ but has no plans of suicide and would never do anything to harm her baby. Her baby has had an appropriate weight gain and is smiling. What diagnosis is most likely?
Baby Blues
Post-natal sleep deprivation
This is normal with a young baby. Shu needs reassurance and support.
Puerperal psychosis
Post-natal depression
Post-natal depression
You are a trainee intern who has been involved in the labour care of Woomi, a 30 year old Korean woman who has just had a normal vaginal birth. Woomi is keen to breast feed, but is unsure about the recommendations. Which of the following are WHO recommendations about exclusive breast feeding?
The baby should breast feed as often as it wants, day or night. Mothers and babies should practice rooming-in together, 24 hours a day. If breast feeding is challenging, then formula top ups should be used.
Breast feeding should be initiated in the first 2 hours of life. The baby should be fed every 2 hours if it wants but not more often than that. Mothers and babies should practice rooming in together, 24 hours a day.
Breast feeding should be initiated in the first hour of life. The baby should breast feed as often as it wants, day or night. The baby should sleep in a separate room to the mother at night to allow her to get some rest and to promote independence.
Breast feeding should be initiated in the first hour of life. The baby should breast feed as often as it wants, day or night. Mothers and babies should be enabled to practice rooming-in together, 24 hours a day. Babies should only receive breast milk without additional food, drink or water.
Breast feeding should be initiated in the first hour of life. The infant should breast feed as often as it wants, day or night. Breast feeding should be discontinued at 12 months.
Breast feeding should be initiated in the first hour of life. The baby should breast feed as often as it wants, day or night. Mothers and babies should be enabled to practice rooming-in together, 24 hours a day. Babies should only receive breast milk without additional food, drink or water.
You are a trainee intern on the birthing suite. You have just seen Ali, a 38 year old Pākehā woman para 3 whose daughter was stillborn 6 hours ago. Ali asks you about suppression of lactation. What advice should you give her?
She should wear a firmly fitting bra and avoid stimulating her breasts. She could take domperidone regularly for the next week.
She should express milk to empty her breasts which will make them more comfortable. She could take domperidone regularly for the next week.
She should fluid restrict. Cabbage leaves and acupuncture will provide relief.
She should express milk to empty her breasts which will make them more comfortable. She could take cabergoline 1mg stat.
She should wear a firmly fitting bra and avoid stimulating her breasts. She could take cabergoline 1mg stat.
She should wear a firmly fitting bra and avoid stimulating her breasts. She could take cabergoline 1mg stat.
You are a trainee intern in a general practice seeing Abbie, a 24 year old para 1 Pākehā woman who birthed two weeks ago via a lift-out forceps for delay in the second stage of labour. Abbie had a long, augmented labour and required an epidural for analgesia. Abbie is concerned that she does not have enough milk. Her baby is constantly feeding, not settling, requiring only a few nappy changes and is still below his birth weight. Abbie reports that her breasts are soft, but that she has cracked nipples. Her breasts were engorged during postnatal days 4-8. Which of the following is the most likely cause of Abbie’s breast feeding difficulties?
Unsatisfactory latch-on technique
Forceps birth
Giving formula on Days 4-8 when the breasts were engorged
Lack of information by staff
Analgesia in labour
Insufficient milk
Unsatisfactory latch on technique
