Chapter 16 - Routine Mx of the puerperium

Which of the following influences the initiation of
lactation?
a. incr levels of prolactin and progesterone
post-delivery
b. length of labour
c. incr levels of prolactin and wdrawal of
progesterone post-delivery
d. the desire of the mother to breastfeed her baby
e. return of progesterone and oestrogen to
pre-delivery levels

The process of involution is usually monitored by which ofthe following?
a. the return of ovulation and menstruation, signifying the process is complete
b. ensuring the woman is able to pass urine post-delivery
c. the transition of lochia rubra to lochia serosa
d. the closing of the internal cervical os
e. palpation of the descent of the uterine fundus

Which of the following is good advice for a woman who has had a c-section for breech presentation?
a. in a subsequent pregnancy, it is important for
the woman to attend early antenatal care and discuss the proposed mod ofdelivery w the obstetrician
b. it is important to avoid intercourse for
3-4months after c-section
c. a repeat c-section is necessary in a subsequent
pregnancy
d. a fetal malpresentation is highly likely to
occur again in her hext pregnancy
e. home birth would be a safe option in her next
pregnancy

Which of the following statements about c-sections is not true?
a. regional analgesia is preferable to gen anaesthesia
b. meds are given before c-section to incr gastric
pH
c. maternal morbidity rates are the same for
vaginal birth as for c-section
d. lower uterine segment c-section is practised to
reduce complications in subsequent pregnancies
e. c-section is assoc w an incr risk of venous
thrombo-embolism when compared to vaginal delivery

Which are the most common clinical signs of endometritis?
a. 2ndary PPH
b. uterine tenderness and vaginal bleeding
c. uterine tenderness, putulent lochia nad fever
d. subinvolution and secondary PPH
e. lower abdo pain and dysuria

Which of the following does not incr the risk of puerperal sepsis?
a. prolonged rupture of membranes
b. frequent use of urinary catheters
c. assisted birth – vacuum or forceps
d. primiparity
e. c-section

A 2nd decree perineal tear does not include which
of the following structures?
a. bulbocaverosus muscle
b. anal sphincter
c. vaginal mucosa
d. transverse perineal muscle
e. perineal skin

Which Ix would you order for a woman with a mild 2ndary PPH
a. FBC
b. Blood group
c. Vaginal cultures
d. US of the uterine cavity
e. All of the above

Which of the following may speculum examination of a woman with a moderate 2ndary PPH show?
a. blood clots in the cervical canal
b. cervical dilatation
c. clinical signs of severe endometritis
d. bleeding from a vaginal tear
e. all of the above

Advice for a woman w a 2nd decree perineal tear should include which of the following?
a. avoidance of intercourse for 3 months
b. reassurance that the wound will be healed in 6/52
c. avoidance of constipation as the tear has involved the rectal sphincter
d. delay in starting pelvic floor exercises until 2/12 postpartum
e. encouragement to keep the area clean and report to the doctor if there is any pain, incr odour or discharge from the site.