Quiz 7: The puerperium

Please choose the one, most correct answer to each question or statement.

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
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
3. In the puerperium stress incontinence:
   • Is common
   • Is uncommon
   • Requires referral to the doctor
   • Is a sign of a urinary tract infection
4. In the puerperium the haemoglobin concentration becomes stable by:
   • 6 weeks
   • Day 7
   • Day 4
   • Day 1
5. In a normal puerperium the cervical os should be closed by:
   • Day 3
   • Day 7
   • Day 14
   • 6 weeks
6. Normal lochia:
   • Is colourless
   • Has no smell
   • Has an offensive smell
   • Has a non-offensive smell
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
8. A normally involuting uterus will be:
   • Soft and tender
   • Soft and not tender
   • Firm and tender
   • Firm and not tender
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.
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.
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
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
13. Which of the following indicate that puerperal pyrexia is caused by a genital tract infection?
    • General malaise
    • Rigors
    • Offensive lochia
    • A marked tachycardia
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
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.
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)
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
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
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
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