The Puerperium

Question 1

When is the puerperium?

Answer 1

6 weeks after delivery

Question 2

At what day after delivery is the uterus no longer felt abdominally?

Answer 2

Day 10

Question 3

How many days after delivery are contractions/’after-pains’ felt?

Answer 3

4 days

Question 4

How many days does it take for the cervix to become firm after delivery?

Answer 4

3 days

Question 5

What is lochia?

Answer 5

1. Endometrial slough, red cells, white cells.
2. Passed per vagina in puerperium
3. Red for 1st three days, then yellow, then white until 6 weeks.

Question 6

When does menstruation resume after delivery?

Answer 6

Occurs at 6 weeks if woman is not lactating (delayed by lactation).

Question 7

How long does it take for physiological signs to return to normal after delivery?

Answer 7

1 week

Question 8

What peaks at 10-14 days post delivery and how is it managed?

Answer 8

1. Pro-thrombotic state

2. If high risk - hydration, mobilisation, TED stocking, LMWH

Question 9

What is puerperal pyrexia?

Answer 9

Temperature over 38 degrees in 1st 14 days after delivery or miscarriage.

Question 10

How should you investigate puerperal pyrexia?

Answer 10

1. Examine chest, breasts, logs, lochia, vagina.

2. Culture MSU, high vaginal swabs, blood and sputum if coughing.

Question 11

How should you treat endometritis in the puerperium?

Answer 11

Urgent IV antibiotics - clindamycin and gentamicin

Question 12

How do you treat mastitis in the puerperium?

Answer 12

Flucloxacillin, advise to continue breastfeeding.

Question 13

How do you treat PUO in the puerperium?

Answer 13

Cefalexin and metronidazole