🤔 MEDIUM

The puerperium period can be both an enjoyable and difficult time for new parents, with a body changing once again to adapt to no longer having to grow another human! Have a go at these questions- good luck! 

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Normal Puerperium and breast feeding

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Question 1

Stem 1, question 1 of 4

Bethany, a 31 year old female, gives birth to a baby. She had a low risk pregnancy and no complications during delivery
What is the puerperium period?
A
Immediately after the delivery of the placenta to the end of the 4th postnatal week and is the process of the body reverting to the non-pregnant state
B
Immediately after the delivery of the placenta to the end of the 5th postnatal week and is the process of the body reverting to the non-pregnant state
C
Immediately after the delivery of the placenta to the end of the 6th postnatal week and is the process of the body reverting to the non-pregnant state
D
Immediately after the delivery of the placenta to the end of the 7th postnatal week and is the process of the body reverting to the non-pregnant state
E
Immediately after the delivery of the placenta to the end of the 8th postnatal week and is the process of the body reverting to the non-pregnant state
Question 1 Explanation: 
Starting off with a definition question to get us into the topic. Puerperium is the period immediately after the delivery of the placenta, aka the final stage of labour, to the end of the 6th post natal week. This is the process of the body reverting to the non-pregnant state.
Question 2

Stem 1, question 2 of 4

10 days after birth, Bethany is still having red lochia. What can this indicate?
A
Compete uterine involution
B
Uterine sub-involution
C
Lactogenesis is occurring
D
First postpartum menstrual period
E
Ovarian involution
Question 2 Explanation: 
Lochia is vaginal discharge from the uterus, cervix and vagina. Initially lochia is red comprising of blood, fragments of decide, endometrial tissues and mucus, lasting 1-4 days. Lochia then changes to yellowish lasting 5-9 days comprised of blood, mucus and leucocytes. Lochia then becomes white and is mostly mucus for a further 10-14. Lochia can persist for 5 weeks postpartum, but red lochia beyond a week can be an indicator of uterine sub-involution.
Question 3

Stem 1, question 3 of 4

The breast tissue is unresponsive to the effects of prolactin in pregnancy, what hormone(s) cause this unresponsive state?
A
High oestrogen
B
High LH and FSH
C
High oestrogen and LH
D
High oestrogen and progesterone
E
High progesterone
Question 3 Explanation: 
High levels of oestrogen and progesterone make the breast tissue unresponsive to prolactin, after these levels decreases rapidly postpartum, prolactin begins milk secretion with lactogenesis occurring on the third or fourth day postpartum.
Question 4

Stem 1, question 4 of 4

Bethany has a visit from the health visitor and asks when she can expect to have her first menstrual period. Beth has chosen not to breast feed.
In a non-breastfeeding person, when does menstrual function normally return by?
A
4-6th postpartum week
B
6-8th postpartum week
C
7-9th postpartum week
D
8-10th postpartum week
E
9-11th postpartum week
Question 4 Explanation: 
If an individual is not breastfeeding than menstrual function returns by 6-8th postpartum week in most cases. This is different in individuals who are breastfeeding, which is much more variable and depends on how often they are breastfeeding.
Question 5

Stem 2, question 1 of 4

Agnieszka, a 34 year old female, has a vaginal delivery of her baby. Blood tests show her haematocrit drops and then progressively rises in the postpartum period.
By what mechanism does haematocrit rise in the postpartum period?
A
Plasma volume increases due to diuresis and haemoconcentration
B
Plasma volume increases due to post partum blood loss
C
Plasma volume decreases due to diuresis and haemoconcentration
D
Plasma volume decreases due to filtration
E
Plasma volume increases due to shift of fluid from intravascular to extravascular space.
Question 5 Explanation: 
Haematocrit or packed cell volume is the volume percentage of erythrocytes in the blood volume. In pregnancy plasma volume expands to prepare for blood loss associated with delivery and so this causes haemodilution and a physiological anaemia. In the post-partum period, plasma volume will decrease due to diuresis and haemoconcentration thus the haematocrit will increase.
Question 6

Stem 2, question 2 of 4

Agnieszka chooses to breastfeed, which of the following is not a benefit of breastfeeding?
A
Reduces risk of Sudden Infant Death Syndrome (SIDS) to baby
B
Reduction in risk of breast and ovarian cancer in individual breastfeeding
C
Provides protecting to baby against diarrhoea and vomiting with fewer admissions to hospital
D
Reduced risk of puerperal mastitis
E
There is no additional cost involved
Question 6 Explanation: 
There are many benefits of breastfeeding and it should be encouraged but individuals always have a choice and/or may not be able to breastfeed and so should be supported. Breast feeding increases the risk of peurperal or lactational mastitis which can lead to a breast abscess formation.
Question 7

Stem 2, question 3 of 4

On a GP visit the doctor discusses with Agnieszka different contraception methods she can use. Up to what point in the peurperium period is contraception not necessary?
A
7 days post partum
B
14 days post partum
C
21 days post partum
D
28 days post partum
E
35 days post partum
Question 7 Explanation: 
Contraception is not necessary in the first 21 days after childbirth. A person should not be started on combined hormonal contraception (pill, vaginal ring or patch) before 21 days post partum due to the increased risk of thromboembolism in the immediate post partum period.
Question 8

Stem 2, question 4 of 4

Intrauterine devices and systems are forms of long-lasting contraception. They should not be fitted before 4 weeks post partum, why?
A
Increased risk of perforating the uterus wall
B
Decreased efficacy
C
Increased risk of post partum thromboembolism
D
Increased risk of expulsion
E
Decreases milk production
Question 8 Explanation: 
Intrauterine devices or systems should not be fitted before 4 weeks postpartum due to an increased risk of expulsion, thus rendering the device completely ineffective. However, note that the Faculty of Sexual and Reproductive Healthcare (pg. 6) says that these devices can also be fitted within 48 hours of delivery. See here for an explanation.
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