Normal Puerperium — MCQs
Uterine height is greater than gestational age of the patient in a case of all except -
After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:
What is the uterine blood flow at term in ml/min?
What will be the level of the uterus on the second day post delivery?
Which condition is responsible for approximately a quarter of postnatal maternal deaths?
After delivery upto which week is known as puerperium?
A woman dies from a heart disease six days after delivery. This would come under the category of :
During immediate puerperium,
What are the causes of lactation failure after delivery ? 1. Infrequent suckling 2. Depression or anxiety state in the puerperium 3. Prolactin inhibition Select the correct answer using the code given below :
Newborn can be given breast milk after how much time following normal delivery?
Normal Puerperium Indian Medical PG Practice Questions and MCQs
Question 1: Uterine height is greater than gestational age of the patient in a case of all except -
- A. Fibroid uterus
- B. Wrong dates
- C. Polyhydramnios
- D. IUGR (Correct Answer)
Explanation: ***IUGR*** - In **Intrauterine Growth Restriction (IUGR)**, the fetus is smaller than expected for gestational age, leading to a **fundal height** that measures less than the actual gestational age. - This condition is characterized by a **restricted growth rate** of the fetus, causing the uterine size to be disproportionately small. *Fibroid uterus* - The presence of **uterine fibroids** (leiomyomas) can increase the overall size of the uterus beyond what would be expected for a given gestational age. - These benign tumors add bulk to the uterine wall, leading to a **larger-than-expected uterine height**. *Wrong dates* - Incorrect estimation of the **Last Menstrual Period (LMP)** or date of conception can lead to a miscalculation of gestational age. - If the gestational age is **underestimated**, the actual uterine height will appear greater than the calculated gestational age. *Polyhydramnios* - **Polyhydramnios** is a condition characterized by an **excessive accumulation of amniotic fluid**, which distends the uterus. - Increased amniotic fluid volume leads to a significantly **larger uterine size** and a fundal height greater than the gestational age.
Question 2: After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:
- A. Check for laceration of labia
- B. Uterine massage and I/V oxytocin
- C. APGAR scoring (Correct Answer)
- D. Check for placenta in uterus
Explanation: ***APGAR scoring*** - **APGAR scoring** assesses the newborn's health immediately after birth and is not a management step for **postpartum hemorrhage**. - This intervention would divert critical attention from the mother's life-threatening bleeding. *Check for placenta in uterus* - **Retained placental fragments** are a common cause of **postpartum hemorrhage**, obstructing uterine contraction. - Checking for and removing any retained placenta is a crucial and immediate management step to control bleeding. *Check for laceration of labia* - **Lacerations of the birth canal**, including the labia, vagina, or cervix, can cause significant bleeding after delivery, even with a well-contracted uterus. - Identifying and repairing these lacerations is an essential part of managing **postpartum hemorrhage not due to atony**. *Uterine massage and I/V oxytocin* - **Uterine atony** (failure of the uterus to contract) is the most common cause of **postpartum hemorrhage**. - **Uterine massage** helps stimulate contraction, and **intravenous oxytocin** is a uterotonic agent used to promote uterine contraction and reduce bleeding.
Question 3: What is the uterine blood flow at term in ml/min?
- A. 50 ml/min
- B. 450 ml/min
- C. 550 ml/min
- D. 750 ml/min (Correct Answer)
Explanation: ***750 ml/min*** - At term, **uterine blood flow** significantly increases to meet the metabolic demands of the fetus and placenta. - Approximately **750 ml/min** is delivered to the uterus, representing a substantial portion of the maternal cardiac output. *50 ml/min* - This flow rate is typical for the **non-gravid uterus** and is significantly lower than what is required during pregnancy. - A flow of 50 ml/min would be insufficient to support fetal growth and placental function at term. *450 ml/min* - While significantly higher than non-gravid flow, **450 ml/min** is still below the average blood flow to the uterus at term. - This rate would likely compromise sufficient nutrient and oxygen delivery to the fetus. *550 ml/min* - Similar to 450 ml/min, **550 ml/min** is an underestimate of the typical uterine blood flow at term. - Adequate fetal well-being in late pregnancy requires a higher rate of blood perfusion to the uteroplacental unit.
Question 4: What will be the level of the uterus on the second day post delivery?
- A. One finger breadth below umbilicus (Correct Answer)
- B. Two finger breadths below umbilicus
- C. Three finger breadths below umbilicus
- D. Four finger breadths below umbilicus
Explanation: ***One finger breadth below umbilicus*** - On the second day postpartum, the **fundus** is typically located approximately **one finger breadth below the umbilicus**. - This reflects the ongoing process of **involution**, where the uterus contracts and descends back into the pelvis. *Two finger breadths below umbilicus* - This level is usually observed around **day 3 or 4 postpartum**, as the uterus continues to involute. - The descent is gradual, making it less likely to be at this level on just the second day. *Three finger breadths below umbilicus* - This position is generally reached around **day 5 or 6 postpartum** as uterine involution progresses. - A uterus at this level on day 2 would suggest a more rapid than usual involution. *Four finger breadths below umbilicus* - This level is more consistent with the uterine position around **day 7 or 8 postpartum**. - On the second day, the uterus would still be considerably higher than this.
Question 5: Which condition is responsible for approximately a quarter of postnatal maternal deaths?
- A. Eclampsia
- B. Anemia
- C. Infection
- D. Postpartum hemorrhage (PPH) (Correct Answer)
Explanation: ***Postpartum hemorrhage (PPH)*** - **Postpartum hemorrhage (PPH)** is the leading cause of maternal mortality worldwide, accounting for roughly a quarter of all postnatal maternal deaths. - PPH is defined as a blood loss of **500 mL or more** within 24 hours after vaginal birth, or **1000 mL or more** after a Cesarean section, and can lead to hypovolemic shock and death if not promptly managed. *Infection* - **Maternal infections**, such as puerperal sepsis, are a significant cause of maternal mortality but typically rank after PPH in overall incidence. - While infections contribute to postnatal deaths, they do not account for as high a proportion as PPH. *Eclampsia* - **Eclampsia** is a severe complication of pre-eclampsia, characterized by seizures, and is a major cause of maternal mortality and morbidity. - Though serious, its contribution to overall maternal deaths, while substantial, is less than that of PPH globally. *Anemia* - **Anemia** in the postpartum period can exacerbate other complications and increase the risk of maternal morbidity, but it is rarely a direct cause of maternal death on its own. - Severe anemia can lower the threshold for adverse outcomes from blood loss or infection but is not a primary cause of death at the same rate as PPH.
Question 6: After delivery upto which week is known as puerperium?
- A. 2 weeks
- B. 4 weeks
- C. 6 weeks (Correct Answer)
- D. 8 weeks
Explanation: ***6 weeks*** - The **puerperium** is the period of approximately **6 weeks** after childbirth during which the mother's body undergoes physiological adaptations to return to its non-pregnant state. - This timeframe allows for the involution of the uterus and the restoration of reproductive organs and systemic physiology. *2 weeks* - This period is too short to encompass the full physiological recovery process after childbirth. - While immediate postpartum changes occur, many maternal systems, such as the reproductive organs, have not fully reverted to their pre-pregnancy state within 2 weeks. *4 weeks* - This duration is still considered an incomplete period for the extensive physiological changes that define the puerperium. - Uterine involution often continues beyond 4 weeks, and other hormonal and systemic adjustments are still ongoing. *8 weeks* - While recovery continues, the primary definition of the puerperium typically concludes at **6 weeks postpartum**. - By 8 weeks, most significant physiological changes have already occurred, and the body is largely back to its pre-pregnant state.
Question 7: A woman dies from a heart disease six days after delivery. This would come under the category of :
- A. Direct maternal death
- B. Unclassified death
- C. Indirect maternal death (Correct Answer)
- D. Medical (non-maternal) death
Explanation: ***Indirect maternal death*** - An **indirect maternal death** is defined as one resulting from a pre-existing disease or a disease that developed during pregnancy, which was not due to direct obstetric causes but was aggravated by the physiological effects of pregnancy. - Heart disease in this context, especially when occurring six days postpartum, is often a pre-existing condition exacerbated by pregnancy-related cardiovascular demands, fitting this definition. *Direct maternal death* - **Direct maternal deaths** are those resulting from obstetric complications of the pregnant state, from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of these. - Examples include severe hemorrhage, pre-eclampsia/eclampsia, or obstructed labor, which are not described in this scenario. *Unclassified death* - An **unclassified death** is assigned when there is insufficient information to determine the cause of death as direct, indirect, or coincidental. - In this case, the cause of death (heart disease) is known, making classification possible. *Medical (non-maternal) death* - This category usually refers to deaths from medical conditions **unrelated to or unaggravated by pregnancy**. - While heart disease is a medical condition, its occurrence six days postpartum strongly suggests that the physiological changes of pregnancy played a significant role in its exacerbation or presentation, thereby classifying it as a maternal death rather than a coincidental non-maternal death.
Question 8: During immediate puerperium,
- A. the number of lymphocytes increases
- B. the number of white cells increases (Correct Answer)
- C. the number of white cells decreases
- D. the number of eosinophils increases
Explanation: ***the number of white cells increases*** - Leukocytosis, or an increase in the number of **white blood cells**, is a common and normal physiological response during the **immediate puerperium**. - This rise in white blood cell count, primarily **neutrophils**, is a protective mechanism against potential infection and aids in the healing process following childbirth. *the number of lymphocytes increases* - While other immune cells contribute to postpartum recovery, a significant increase in **lymphocytes** is not the primary expected change in the immediate puerperium. - Lymphocyte counts may fluctuate but do not typically show the same dramatic immediate increase as neutrophils. *the number of white cells decreases* - A decrease in the number of **white cells** during the immediate puerperium would be an abnormal finding and could indicate a developing complication, such as **immunosuppression** or a severe infection. - Normal physiological changes post-delivery involve an **increase** in white blood cell count as part of the body's recovery and protective mechanisms. *the number of eosinophils increases* - An increase in **eosinophils** is usually associated with **allergic reactions**, parasitic infections, or certain autoimmune conditions. - It is not a typical or expected physiological finding in the immediate postpartum period, and a significant rise might warrant further investigation.
Question 9: What are the causes of lactation failure after delivery ? 1. Infrequent suckling 2. Depression or anxiety state in the puerperium 3. Prolactin inhibition Select the correct answer using the code given below :
- A. 1 and 2 only
- B. 2 and 3 only
- C. 1 and 3 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Infrequent suckling** directly reduces the stimulation needed for **prolactin release** and **milk production**, leading to lactation failure. - **Depression or anxiety** can interfere with the **let-down reflex** by inhibiting **oxytocin release** and also decrease a mother's motivation and ability to breastfeed effectively. - Any condition causing **prolactin inhibition**, such as certain medications (e.g., dopamine agonists) or specific medical conditions (e.g., Sheehan's syndrome), will directly prevent milk synthesis. *1 and 2 only* - This option correctly identifies infrequent suckling and emotional states as causes but fails to include **prolactin inhibition**, which is a direct and significant physiological factor in lactation failure. - Excluding **prolactin inhibition** provides an incomplete understanding of all potential causes for inadequate milk production. *2 and 3 only* - This option correctly recognizes the impact of emotional states and prolactin inhibition but overlooks **infrequent suckling**, which is one of the most common behavioral reasons for reduced milk supply. - Lack of adequate and frequent nipple stimulation is crucial for establishing and maintaining a robust milk supply. *1 and 3 only* - This option correctly identifies infrequent suckling and prolactin inhibition but omits the significant role of **maternal psychological states** like depression and anxiety in successful lactation. - Emotional well-being heavily influences the **milk ejection reflex** and overall breastfeeding success.
Question 10: Newborn can be given breast milk after how much time following normal delivery?
- A. Half hour
- B. 2 hours
- C. 1 hour (Correct Answer)
- D. 3 hours
Explanation: ***1 hour*** - Initiating breastfeeding **within 1 hour** after a normal vaginal delivery is the **WHO and UNICEF recommended standard** for optimal newborn care. - This practice, often called the **"golden hour"**, allows the newborn to benefit from **colostrum** (rich in antibodies and nutrients), promotes **mother-infant bonding**, and helps stimulate **uterine contractions** to reduce postpartum hemorrhage. - Early initiation within this timeframe supports **successful establishment of breastfeeding** and improves exclusive breastfeeding rates. *Half hour* - While initiating breastfeeding within 30 minutes is **excellent and encouraged**, the standard guideline allows up to 1 hour. - Immediate or very early feeding (within 30 minutes) is ideal when mother and baby are stable, but the flexibility up to 1 hour accommodates immediate postpartum care needs. *2 hours* - Delaying breastfeeding until 2 hours post-delivery **exceeds the recommended window** and can lead to the infant becoming **less alert** and less interested in feeding. - This delay is associated with **lower rates of successful exclusive breastfeeding** and may impact milk supply establishment. *3 hours* - A 3-hour delay in initiating breastfeeding is **significantly beyond recommended guidelines** after a normal, uncomplicated delivery. - Such delays can contribute to **poor latch**, **infant fatigue**, increased **formula supplementation**, and may hinder **long-term breastfeeding success**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free