The puerperium

Question 1

What is the puerperium?

Answer 1

6 weeks following delivery

Question 2

Give uterine changes in the puerperium?

Answer 2

involutes from 1kg to 100g
felt at umbilicus after delivery
becomes pelvic organ at 10 days
pains due to its contractions

Question 3

Give cervical changes in puerperium

Answer 3

firms over 3 days
internal os closes by 3 days
external os closes by 3 weeks

Question 4

What is lochia

Answer 4

endometrial slough, red and white cells

Question 5

When is lochia normally red

Answer 5

first 3 days

Question 6

When does lochia change from yellow to white?

Answer 6

over the next 10 days

then stays white until 6 weeks

Question 7

When does milky discharge appear from the breasts?

Answer 7

during last trimester

Question 8

when does milk replace colostrum?

Answer 8

3 days after birth

Question 9

what are swollen, red and tender breasts a sign of at 3-4 days?

Answer 9

physiological engorgement

Question 10

What should be given if women are Rh-ve?

Answer 10

anti D within 72 hrs

Question 11

What are signs of endometritis or retained products?

Answer 11

persistent red lochia
failure of uterine involution
PPH

Question 12

immunity to what should be checked in the first few days after birth?

Answer 12

rubella

Question 13

What is puerperal Pyrexia defined as

Answer 13

Temp >38 in the first 14 days after delivery OR miscarriage

Question 14

what are ix for puerperal pyrexia

Answer 14

MSU culture, high vaginal swabs, blood and sputum

Question 15

what are the main causes of puerperal pyrexia

Answer 15

endometritis: most common cause
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism

Question 16

What is rx of puerperal pyrexia

Answer 16

cephalexin + metronidazole

Question 17

What are the signs of endometritis

Answer 17

lower abdominal pain
offensive lochia
tender uterus on BMV

Question 18

What is rx of endometritis

Answer 18

clindamycin and gentamicin until afebrile for greater than 24 hours

Question 19

What is the treatment of breast infection

Answer 19

flucloxacillin for 10 or more days to prevent abscesses

Question 20

Should breastfeeding be continued w breast infection?why or why not

Answer 20

continue to prevent milk stagnation

Question 21

What is superficial thrombophlebitis what is the rx

Answer 21

painful tender vein
NSAID
stockings

Question 22

what is involves in 6 week postnatal examination regarding the mother

Answer 22

• Looking at baby and mother rship
• BP and weight
• FBC if anaemic
• Cervical smear if due
• Check contraceptive plans

Question 23

Explain how lactational amenorrhoea works

Answer 23

Breastfeeding delays return of ovulation

Question 24

when is lactational amenorrhoea most effective?

Answer 24

fully breastfeeding day and night, <6m postpartum and amenorrhoeic

Question 25

When is average first menstruation after birtuh?

Answer 25

28.4 weeks

Question 26

When is lactational amenorrhoea less effective?

Answer 26

• Periods return
• > 6m
• breastfeeding frequency
• Night feeding stops
• Separation from the baby
• Mother or baby become ill or stressed

Question 27

When can pOP be started postpartum?

Answer 27

any time

Question 28

When can COCP be started postpartum?

Answer 28

3w if not breastfeeding

Question 29

When is it recommended to start depot in breastfeeding women?

Answer 29

after 6 weeks

Question 30

What drug is involved in depot and when can it be given if not breastfeeding?

Answer 30

medroxyprogesterone acetate 5 days postpartum

Question 31

When can progesterone implants be given?

Answer 31

after 6w in breastfeeding

21-28 if not breastfeeding

Question 32

When is IUD inserted postpartum?

Answer 32

either in first 48hrs
or
until 4 weeks