Quiz 12: The Puerperium

Question 1

The puerperium starts:

When the infant is delivered

When the placenta is delivered

One hour after delivery of the infant

24 hours after delivery of the placenta

Answer 1

When the placenta is delivered

Question 2

Soon after a normal delivery a healthy patient’s pulse rate should be:

Below 80 beats per minute

Below 100 beats per minute

Below 120 beats per minute

Above 100 beats per minute

Answer 2

Below 100 beats per minute

Question 3

In the puerperium stress incontinence:

Is common

Is uncommon

Requires referral to the doctor

Is a sign of a urinary tract infection

Answer 3

Is common

Question 4

In the puerperium the haemoglobin concentration becomes stable by:

6 weeks
Day 7
Day 4
Day 1

Answer 4

Day 4

Question 5

In a normal puerperium the cervical os should be closed by:

Day 3
Day 7
Day 14
6 weeks

Answer 5

Day 7

Question 6

Normal lochia:

Is colourless
Has no smell
Has an offensive smell
Has a non-offensive smell

Answer 6

Has a non-offensive smell

Question 7

On day seven postpartum the size of a normally involuting uterus should correspond to a gestational age of approximately:

8 weeks
12 weeks
16 weeks
20 weeks

Answer 7

12 weeks

Question 8

A normally involuting uterus will be:

Soft and tender
Soft and not tender
Firm and tender
Firm and not tender

Answer 8

Firm and not tender

Question 9

Which of the following statements is the most important one when considering the first hour following delivery of the placenta?

The blood pressure and pulse rate must be determined every 15 minutes.

The haemoglobin concentration must be estimated.

The patient must pass urine during this period.

Ensure continuously that the uterus is well contracted.

Answer 9

Ensure continuously that the uterus is well contracted.

Question 10

To prevent a postpartum haemorrhage after delivery of the placenta:

The patient must be shown how to rub up the uterus.

An intravenous infusion should be started before every delivery.

An intravenous infusion with 20 units of oxytocin should be put up after delivery of the placenta.

The haemoglobin concentration must be estimated every 2 hours for the first 12 hours after delivery.

Answer 10

The patient must be shown how to rub up the uterus.

Question 11

How frequently should a primipara visit the clinic for postpartum care in the puerperium?

At least daily for seven days

At least daily for 5 days and again on day seven

At least once between days 3 and 6

The patient must be kept in hospital for at least 5 days

Answer 11

At least once between days 3 and 6

Question 12

A patient has puerperal pyrexia if her temperature:

Rises to 37.3 °C and is maintained for 24 hours during the first 10 days postpartum

Rises to 38 °C or higher and is maintained for 24 hours during the first 10 days postpartum

Rises to 37.5 °C on two occasions during the first 10 days postpartum

Rises to 38 °C or higher during the puerperium

Answer 12

Rises to 38 °C or higher during the puerperium

Question 13

Which of the following indicate that puerperal pyrexia is caused by a genital tract infection?

General malaise
Rigors
Offensive lochia
A marked tachycardia

Answer 13

Offensive lochia

Question 14

How must a patient with a urinary tract infection causing puerperal pyrexia be treated?

Admission to hospital for intravenous broad-spectrum antibiotics

Admission to hospital, tepid sponging and paracetamol to bring down the temperature

Oral broad-spectrum antibiotics given to the patient at home

Oral broad-spectrum antibiotics and paracetamol given to the patient at home

Answer 14

Admission to hospital for intravenous broad-spectrum antibiotics

Question 15

If a patient presents with puerperal pyrexia, it would be most important to:

Hospitalise the patient and start her on ampicillin and metronidazole (Flagyl).

Treat the patient with ampicillin and metronidazole (Flagyl) at home.

Hospitalise the patient and immediately start with tepid sponging and paracetamol to bring down the temperature.

Find the cause of the pyrexia and start the appropriate treatment.

Answer 15

Find the cause of the pyrexia and start the appropriate treatment.

Question 16

A patient who develops the ‘puerperal blues’ needs to be:

Referred to a psychiatrist

Isolated together with her infant

Comforted and given an explanation of her feelings

Treated with a benzodiazepine (e.g. Ativan)

Answer 16

Comforted and given an explanation of her feelings

Question 17

What is a secondary postpartum haemorrhage?

Any vaginal bleeding that appears excessive, after the first hour following delivery of the placenta

Any vaginal bleeding that appears excessive, after the first 24 hours following delivery of the placenta

Any vaginal bleeding that appears excessive, between the fifth and 15th day of the puerperium

Any vaginal bleeding in the puerperium which is severe enough to cause the patient to become shocked

Answer 17

Any vaginal bleeding that appears excessive, after the first 24 hours following delivery of the placenta

Question 18

What is the most common cause of a secondary postpartum haemorrhage?

Intra-uterine infection with or without a retained piece of placenta

An infected slough of the cervix or vagina

Breakdown of a Caesarean section scar

Gestational trophoblastic disease

Answer 18

Intra-uterine infection with or without a retained piece of placenta

Question 19

The treatment of a patient with a secondary postpartum haemorrhage will include:

Ampicillin and metronidazole (Flagyl)

Syntometrine and/or oxytocin

Removal of retained products of conception under spinal or general anaesthesia

All of the above

Answer 19

All of the above

Question 20

Observations of the presence or absence of offensive lochia in the patient or jaundice in her infant in the puerperium:

Can be made by the patient as well as the midwife

Should not be expected from patients as they are too unreliable

Should only be made by a midwife or doctor

Should only be made by a doctor

Answer 20

Can be made by the patient as well as the midwife