Quiz 6: The puerperium and family planning

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

1. Normal lochia:
   • Is colourless.
   • Has no smell.
   • Has an offensive smell.
   • Has a non-offensive smell.
2. In the puerperium stress incontinence:
   • Is common
   • Is uncommon
   • Requires referral to the doctor
   • Is a sign of a urinary tract infection
3. 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.
4. A normal involuting uterus will be:
   • Soft and tender.
   • Soft and not tender.
   • Firm and tender.
   • Firm and not tender.
5. How frequently should a primipara visit the clinic for postpartum care in the puerperium?
   • At least daily for 7 days.
   • At least daily for 5 days and again on day 7.
   • At least on day 3 and 7.
   • The patient must be kept in hospital for at least 5 days.
6. Which of the following indicate that puerperal pyrexia is caused by a genital tract infection?
   • General malaise.
   • Rigors.
   • Offensive lochia.
   • A marked tachycardia.
7. 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.
8. How must a patient with a urinary tract infection causing puerperal pyrexia be treated?
   • Admission to hospital for intravenous broad-spectrum antibiotics.
   • Tepid sponging and paracetamol to bring down the temperature at a clinic.
   • Oral broad-spectrum antibiotics given to the patient at home.
   • Oral broad-spectrum antibiotics and paracetamol given to the patient at home.
9. 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).
10. 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 5th and 15th days of the puerperium.
    • Any vaginal bleeding in the puerperium which is severe enough to cause the patient to become shocked.
11. The most important aim of family planning is to:
    • Save money.
    • Improve the quality of life for everyone.
    • Prevent sexually transmitted diseases.
    • Ensure that each family has one child only.
12. The correct way to advise a woman regarding a suitable contraceptive method is to:
    • Ask her which method she would like and then consider if it is a suitable choice.
    • Prescribe the method that you think would be the best.
    • Suggest that she use Ovral as a postcoital contraceptive.
    • Allow her to use whatever method she chooses.
13. One of the very effective contraceptive methods is:
    • The condom.
    • Breastfeeding.
    • An intra-uterine contraceptive device.
    • Spermicides.
14. Postcoital contraception with Norlevo, E-Gen-C or Ovral should be offered to a woman who has had a single episode of unprotected sexual intercourse:
    • Five days ago.
    • Seven days ago.
    • Ten days ago.
    • When she misses her next expected period.
15. Lactation is reduced by:
    • The progestogen-only pill (minipill).
    • An intra-uterine contraceptive device.
    • An injectable, e.g. depot progestogen.
    • A combined oral contraceptive pill.
16. The side effects of injectable contraceptives (depot progestogens) include:
    • Fluid retention and breast tenderness.
    • Reduction in lactation.
    • Chloasma (a brown mark on the face).
    • Amenorrhoea.
17. Tubal ligation causes:
    • Menstrual abnormalities.
    • Weight gain.
    • Headaches.
    • None of the above.
18. An advantage of the condom as a method of contraception is that it:
    • Is very effective.
    • Decreases the risk of sexually transmitted disease.
    • Increases sensation during intercourse.
    • Is socially acceptable to everyone.
19. Which contraceptive method is most appropriate for a teenager who has had an unplanned pregnancy?
    • An intra-uterine contraceptive device.
    • An implant.
    • A combined oral contraceptive pill.
    • Postcoital contraception.
20. When would be the most appropriate time to insert an intra-uterine contraceptive device after delivery?
    • Immediately after delivery.
    • 2 weeks postpartum.
    • 6 weeks postpartum.
    • Not earlier than 3 months postpartum.