Normal Puerperium

Question 1

Why is immediate cord clamping after delivery not recommended?

Answer 1

Reduces the red blood cells that an infant receives by more than 50%

Question 2

With delayed cord clamping, there is a higher red blood cell flow to vital organs in the first week - what effects does this have?

Answer 2

Less infant anaemia at 2 months and increased duration of early breastfeeding

Question 3

Delayed cord clamping should be carried out unless what is necessary?

Answer 3

Immediate resuscitation

Question 4

Cord clamping should be delayed by how long after delivery?

Answer 4

3 minutes

Question 5

What are the advantages of skin-skin contact after birth?

Answer 5

Keeps the baby warm and calm and is thought to improve transition to life outside the womb

Question 6

What is the current recommendation for skin-skin contact after birth?

Answer 6

Uninterrupted skin-skin contact for 1 hour following birth

Question 7

Expulsion of the placenta usually occurs how long following birth? Up to when would be considered normal?

Answer 7

5-10 minutes / 30 minutes

Question 8

What are some signs of placental separation in the 3rd stage of labour?

Answer 8

Uterus contracts, hardens and rises / umbilical cord lengthens / gush of blood occurs (variable in amount)

Question 9

What is placental separation?

Answer 9

The placenta separates at the spongey layer of the decidua basalis due to shearing force

Question 10

What is the major advantage of active management of the third stage of labour?

Answer 10

Reduces risk of PPH by 60%

Question 11

What drugs are used to actively manage the 3rd stage of labour?

Answer 11

Uterotonic drugs which increase uterine muscle tone

Question 12

What are the two ways that uterotonic drugs can be given in the active management of 3rd stage?

Answer 12

10U oxytocin IM alone or 5U oxytocin with 500microgram ergometrine IM (Syntometerine)

Question 13

Both ways of giving uterotonic drugs are equally effective at what?

Answer 13

Reducing risk of PPH > 1l

Question 14

What is the a) advantage and b) disadvantage of using Syntometerine over oxytocin alone as active management of the 3rd stage?

Answer 14

a) Better at reducing small haemorrhages b) side effects include nausea and vomiting

Question 15

Apart from uterotonic drugs, what are some other ways of actively managing the 3rd stage of labour?

Answer 15

Cord clamping and cutting, controlled cord traction and bladder emptying

Question 16

What is a normal blood loss in delivery? What would be abnormal? What would be significant?

Answer 16

< 500mls / > 500mls / > 1l

Question 17

If there is any blood loss in labour apart from the initial ‘show’ what should be done?

Answer 17

Referral to a consultant led unit

Question 18

What is the puerperium and how long does it last?

Answer 18

A period of repair and recovery, the return to a non-pregnant state which takes around 6 weeks

Question 19

What is lochia? How long does it last?

Answer 19

Vaginal discharge containing blood, mucus and endometrial castings / lasts 4-6 weeks

Question 20

What type of vaginal discharge is seen 3-4 days after delivery?

Answer 20

Rubra (fresh blood)

Question 21

What type of vaginal discharge is seen 4-14 days after delivery?

Answer 21

Serosa (brownish-red, watery blood)

Question 22

What type of vaginal discharge is seen 10-20 days after delivery?

Answer 22

Alba (yellow)

Question 23

In a non-breastfeeding woman, when does menstruation begin following delivery?

Answer 23

Around 8 weeks

Question 24

Why is menstruation delayed in women who are breastfeeding?

Answer 24

Prolactin inhibits FSH production and prevents ovulation

Question 25

When after delivery does the uterus begin to return to its non-pregnant state?

Answer 25

Immediately after delivery of the placenta

Question 26

What happens in uterine involution?

Answer 26

Shortening of muscle fibres and death of excess myometrial cells

Question 27

The fundal height returns from umbilical to pelvic after how long?

Answer 27

2 weeks

Question 28

Failure of involution can be caused by what?

Answer 28

Retained placental fragments and infection

Question 29

What are some areas of the body which never return to their pre-pregnancy state?

Answer 29

Cervix, vagina and perineum

Question 30

What happens to the decidua after delivery?

Answer 30

It is shed and replaced with new endometrium

Question 31

What does breast milk provide babies with?

Answer 31

Passive immunity and nourishment

Question 32

What initiates lactation?

Answer 32

Expulsion of the placenta and a reduction in oestrogen and progesterone

Question 33

When do the breasts become capable of producing milk? Why does this not happen?

Answer 33

20 weeks of pregnancy, but is inhibited by progesterone and oestrogen inhibiting prolactin

Question 34

What is colostrum?

Answer 34

A thick, yellow fluid produced in the first few days of the baby's life

Question 35

What is found in colostrum?

Answer 35

Immunoglobulins and growth factors to mature the gut