Puerperium

Question 1

Obstetric palsy is AKA

Answer 1

traumatic neuritis

Question 2

What is obstetric palsy?

Answer 2

One or both limbs may develop signs of a motor and/or sensory neuropathy following delivery

Question 3

Cause of obstetric palsy?

Answer 3

Compression of lumbosacral trunk as it crosses the sacroiliac joint during descent of fetal head

Question 4

Presentation of obstetric palsy

Answer 4

Sciatic pain
Foot drop
Paresthesia
Hypoesthesia
Muscle wasting

Question 5

Tx of obstetric palsy

Answer 5

Orthopedic opinion
Bed rest
Analgesia
Physiotherapy

Question 6

Peroneal nerve palsy presents with _________________

Answer 6

unilateral foot drop

Question 7

Secondary postpartum hemorrhage

Answer 7

Bleeding from genital tract b/w 24 hours to 6 weeks after delivery

Question 8

Most common time of Secondary PPH

Answer 8

7-14 days

Question 9

Causes of Secondary PPH

Answer 9

Endometritis
Retained placenta

Question 10

Signs of Endometritis

Answer 10

Constant lower abdominal pain
Tender uterus and closed os
Fever and pungent lochia

Question 11

Signs of Retained placenta

Answer 11

Crampy lower abdominal pain
Uterus enlarged and open os
Fever and pungent lochia

Question 12

What is puerperal pyrexia?

Answer 12

Raised temperature (>100.4/>38) on any two days of the first 10 days postpartum, exclusive of 24 hours

Question 13

Causes of puerperal pyrexia

Answer 13

Endometritis (Most common)
Retained placental tissue
Pneumonia, Pulmonary embolism
DVT
Pyelonephritis
Meningitis
Mastitis/Breast Abscess

Question 14

Puerperal sepsis is ______________

Answer 14

polymicrobial

Question 15

Investigations in puerperal sepsis

Answer 15

CBC
UCE
CP
High vaginal swab
Pelvic ultrasound
ABGs

Question 16

Tx of Puerperal sepsis

Answer 16

Cephalosporin
Metronidazole
Clindamycin
IVF
Drainage of pelvic abscess

Question 17

Complications of puerperal sepsis

Answer 17

Ascending infection
Necrotizing fascitis of genital tract (clostridium perfringens)
Endometritis
Hematogenous and lymphatic spread

Question 18

Postpartum Pink and Blues
Pink (Euphoric mood) time
Blue (Depressive mood) time

Answer 18

Pink time 24-48 hours
Blue time first 2 weeks

Question 19

Postpartum pink and blues management

Answer 19

resolves within 10 days
Support

Question 20

Postpartum psychosis is common in week _________ and _____th day

Answer 20

within 3 weeks
5th day most common and rarely before 3rd day

Question 21

PPP risk factors

Answer 21

Hx of Bipolar/PPP
F Hx of Bipolar/PPP

Question 22

Management of PPP

Answer 22

Psychiatric consultation
Lithium
Antidepressants
Acute neuroleptics
ECT
Lithium prophylaxis in high risk patients

Question 23

Postpartum Depression presents in _______th week

Answer 23

6th

Question 24

Features of breast milk

Answer 24

75 kcal/mL
Whey protein
Polyunsaturated FAs
Safe in children with gastroenteritis
All vitamins except Vitamin K
Iron concentration is low
Iron absorption is high due to lactoferrin

Question 25

WHO recommends breastfeeding for _____ months with the introduction of other foods onwards

Answer 25

4-6 months

Question 26

For how long a woman should breastfeed her child?

Answer 26

2 years

Question 27

Benefits of breastfeeding

Answer 27

Cheap Readily available at the right temperature Benefits to country Reduces illness Reduces fertility with amenorrhea Reduces atopic illness Reduces necrotizing enterocollitis Reduces Juvenile diabetes Reduces Cancer Reduces chances of PPH

Question 28

HIV infected women should not breastfeed if _____________

Answer 28

they live in a resource rich setting

Question 29

HIV infected women should breastfeed if they

Answer 29

live in poor resources setting

Question 30

Suppression of lactation can be by

Answer 30

Cabergoline Bromocriptine

Question 31

Noninfective vs Infective mastitis causes

Answer 31

Noninfective → Restriction of feeding and bad position Infective → Nipple trauma (S. Aureus/ Streptococcus viridians) from baby's nose MC or infected umbilical cord

Question 32

Management of noninfective mastitis

Answer 32

Continue feeding from the breast Correct positioning Ice packs Analgesia Avoid compression

Question 33

Management of Infective Mastitis

Answer 33

Cease breastfeeding from affected side Antibiotics I/D (on US) Breastfeeding continued)