Postpartum Care — MCQs

Postpartum Care Indian Medical PG Practice Questions and MCQs

Question 181: Which of the following steps has proven benefit in decreasing puerperal infection following cesarean section?

A. Administration of single dose of ampicillin or 1st generation cephalosporin at the time of cesarean (Correct Answer)
B. Non closure of peritoneum
C. Single layer uterine closure
D. Skin closure with staples than with suture

Explanation: ***Administration of single dose of ampicillin or 1st generation cephalosporin at the time of cesarean*** - Prophylactic **antibiotics** administered prior to skin incision significantly reduce the risk of **puerperal infection** (e.g., endometritis, wound infection) following cesarean section. - The timing of administration (within 60 minutes of skin incision) is crucial for optimal effectiveness, typically using a **first-generation cephalosporin** or **ampicillin** for broad-spectrum coverage. *Non closure of peritoneum* - Studies have shown that **non-closure of the visceral and parietal peritoneum** during cesarean section has no significant impact on the rate of puerperal infection. - While it may shorten operative time and reduce pain, it does not offer a demonstrable benefit in reducing postoperative infections. *Single layer uterine closure* - **Single-layer uterine closure** has been found to be comparable to double-layer closure in terms of postoperative infection rates and uterine healing. - There is no strong evidence to suggest that single-layer closure specifically decreases the incidence of puerperal infection more effectively than double-layer closure. *Skin closure with staples than with suture* - The choice between **staples and sutures** for skin closure after cesarean section does not show a consistent difference in the incidence of **wound infection**. - While staples may be faster and might reduce suture-related complications, they do not inherently decrease the overall risk of puerperal infection compared to traditional suturing.

Question 182: PGF2 alpha maximum dose in PPH management that can be given over 24 hours is:

A. 20 mg
B. 200 mg
C. 2 mg (Correct Answer)
D. 250 mg

Explanation: ***2 mg*** - The maximum recommended dose of **PGF2 alpha** (carboprost tromethamine) in a 24-hour period for PPH management is **2 mg**. - This is typically administered as 250 mcg (0.25 mg) intramuscularly every 15-90 minutes, with a total dose not exceeding 2 mg. *20 mg* - This dose is significantly higher than the recommended maximum for **PGF2 alpha** in PPH and would likely lead to severe adverse effects. - Exceeding the 2 mg limit can increase the risk of gastrointestinal, cardiovascular, and pulmonary complications. *200 mg* - This is an extremely high and dangerous dose of **PGF2 alpha**, far beyond any therapeutic range for PPH management. - Such a dose would almost certainly result in life-threatening complications. *250 mg* - While individual doses of **PGF2 alpha** are 250 mcg (0.25 mg), a total dose of 250 mg over 24 hours is vastly excessive. - This value likely confuses the single dose amount with a significantly larger incorrect total.

Question 183: In Peripartum cardiomyopathy, cardiac failure occurs at:-

A. Within 24 months after delivery.
B. Within 5 months after delivery. (Correct Answer)
C. Within 6 weeks after delivery.
D. Within 7 days after delivery.

Explanation: ***Within 5 months after delivery.*** - Peripartum cardiomyopathy (PPCM) is defined as the development of **cardiac failure** in the **last month of pregnancy** or within **5 months after delivery**, in the absence of any other identifiable cause. - Among the given options, "within 5 months after delivery" represents the **postpartum component** of the diagnostic timeframe and is the most complete answer. - This time frame is a key diagnostic criterion recognized by major cardiology societies (some recent guidelines extend this to 6 months postpartum). - **Note:** The complete definition includes both antepartum (last month of pregnancy) and postpartum (up to 5 months) periods. *Within 24 months after delivery.* - This timeframe is **too broad** and does not align with the standard diagnostic criteria for PPCM. - While some women may experience ongoing cardiac dysfunction or relapse, the initial diagnosis of PPCM is restricted to within 5 months postpartum. - Extended cardiac issues beyond 5 months may represent persistent PPCM or dilated cardiomyopathy rather than new-onset PPCM. *Within 6 weeks after delivery.* - While many cases of PPCM manifest within **6 weeks postpartum** (the traditional puerperium), this definition is **too restrictive**. - Symptoms can appear up to **5 months after delivery**, and using only 6 weeks would miss a significant proportion of cases. - This period captures the most acute presentations but doesn't encompass the entire recognized diagnostic window. *Within 7 days after delivery.* - The onset within **7 days after delivery** represents only the **immediate postpartum period** and is an overly narrow definition. - PPCM can develop much later in the postpartum period (up to 5 months), making this timeframe inadequate for diagnosis. - Using this restrictive criterion would result in many missed diagnoses.

Question 184: A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

A. Incision and drainage (Correct Answer)
B. Analgesics and continue breast feeding
C. Antipyretic
D. Stop lactation

Explanation: ***Incision and drainage*** - A **fluctuant, painful mass** in the breast combined with **fever** 14 days postpartum strongly indicates a **breast abscess**, which requires surgical drainage as the definitive treatment. - **I&D removes the pus collection** and is the preferred treatment for an established abscess, usually combined with **appropriate antibiotics** (though the primary intervention is drainage). - After drainage, breastfeeding can typically be **continued from the unaffected breast** while the affected side heals. *Analgesics and continue breast feeding* - While analgesics can relieve pain and continuing breastfeeding is appropriate for **simple mastitis**, these measures are **insufficient for an established abscess** with a fluctuant collection. - An abscess requires drainage; conservative management alone will not resolve a loculated pus collection. *Antipyretic* - An antipyretic will help reduce the **fever symptomatically**, but it does not address the underlying **purulent collection or infection**. - It would only mask symptoms without treating the cause, potentially delaying appropriate surgical intervention. *Stop lactation* - Stopping lactation abruptly can lead to **breast engorgement** and may worsen milk stasis, potentially complicating the infection. - While temporary cessation from the affected breast during acute infection might be considered, outright stopping lactation is **not the preferred primary treatment** for an abscess and may interfere with recovery.

Question 185: A 24-year-old woman who had a home delivery 2 weeks ago now presents with a complete perineal tear. What is the next line of management?

A. Repair after 3 weeks
B. Repair after 6 months
C. Repair after 3 months (Correct Answer)
D. Repair immediately

Explanation: ***Repair after 3 months*** - Delayed repair, typically after **3 to 6 months**, allows for resolution of **inflammation**, re-epithelialization of the wound edges, and softening of the scar tissue. - This timing optimizes conditions for successful surgical reconstruction by minimizing the risk of **infection** and promoting better tissue healing. *Repair after 3 weeks* - Repairing a complete perineal tear at this stage is too early as the tissue is still highly **inflamed** and prone to **infection** and **dehiscence**. - The wound bed would not have sufficiently healed or softened, making surgical repair more challenging and increasing the likelihood of poor outcomes. *Repair after 6 months* - Waiting for 6 months to repair a complete perineal tear is generally considered too long, as the tissues may become excessively **fibrotic** and less amenable to successful reconstruction. - While sometimes necessary in complex cases, waiting this long can lead to prolonged discomfort and functional issues for the patient. *Repair immediately* - Immediate repair of a complete perineal tear that was missed or inadequately repaired at the time of delivery is typically not recommended several weeks postpartum due to significant **edema**, **inflammation**, and potential for **infection**. - Immediate repair is usually performed **at the time of delivery** if the tear is recognized, not two weeks later.

Question 186: All of the following drugs are used for prevention of PPH, EXCEPT:

A. Misoprostol
B. Oxytocin
C. Dinoprostone (Correct Answer)
D. PGF-2 alpha

Explanation: ***Dinoprostone*** - **Dinoprostone** is a prostaglandin E2 analog primarily used for **cervical ripening** and **labor induction**. - While it can cause uterine contractions, it is **not commonly used** for the prevention or treatment of postpartum hemorrhage (PPH) because other uterotonics are more effective and have a better safety profile for this specific indication. *Misoprostol* - **Misoprostol** is a synthetic prostaglandin E1 analog and is a highly effective uterotonic agent used for both the **prevention and treatment of PPH**. - It works by inducing **strong uterine contractions**, which helps to reduce blood loss after delivery. *Oxytocin* - **Oxytocin** is the first-line and most common uterotonic agent used for the **prevention and treatment of PPH**. - It causes rapid and sustained **uterine contractions**, which compress blood vessels in the uterus and prevent excessive bleeding. *PGF-2 alpha* - **PGF-2 alpha**, specifically **Carboprost tromethamine** (Hemabate), is a prostaglandin F2 alpha analog used to **treat PPH** when other agents like oxytocin are ineffective or contraindicated. - It induces **powerful uterine contractions** and is often reserved for severe cases of PPH.

Question 187: A 28-year-old postpartum woman presents with uterine atony and heavy bleeding. Which medication should be avoided due to a history of hypertension?

A. Carboprost
B. Misoprostol
C. Oxytocin
D. Methylergonovine (Correct Answer)

Explanation: ***Methylergonovine*** - **Methylergonovine** is contraindicated in patients with **hypertension** due to its potent vasoconstrictive effect, which can lead to a hypertensive crisis, stroke, or myocardial infarction. - This medication should be avoided in a postpartum woman with a history of hypertension to prevent severe cardiovascular complications while treating uterine atony. *Carboprost* - **Carboprost** is a prostaglandin F2-alpha analog that can cause **bronchoconstriction** and is contraindicated in patients with asthma. - While it can cause transient hypertension, it is generally considered safer than methylergonovine in patients with a history of hypertension. *Misoprostol* - **Misoprostol** is a synthetic prostaglandin E1 analog that can be safely used in patients with hypertension. - Its primary side effects include **diarrhea**, shivering, and fever, rather than significant cardiovascular effects. *Oxytocin* - **Oxytocin** is the first-line uterotonic agent for preventing and treating postpartum hemorrhage and is safe to use in patients with hypertension. - While large doses can cause **hypotension** and **tachycardia**, it does not typically exacerbate pre-existing hypertension.

Question 188: A 28-year-old woman, G2 P1, with severe PPH unresponsive to oxytocin presents with hypotension and tachycardia. She has a soft uterus and ongoing bleeding. What is the next best step in management?

A. IM carboprost (Correct Answer)
B. Immediate hysterectomy
C. Expectant management
D. IV tranexamic acid

Explanation: ***IM carboprost*** - The **soft uterus** with ongoing bleeding despite oxytocin indicates **uterine atony** as the cause of PPH - Carboprost (PGF2α) is the **standard second-line uterotonic agent** after oxytocin failure - Effectively stimulates strong **uterine contractions** to control hemorrhage from the placental bed - Given intramuscularly at **0.25 mg every 15-90 minutes** (maximum 8 doses) - Contraindicated in active cardiac, pulmonary, or hepatic disease *Immediate hysterectomy* - Peripartum hysterectomy is a **last-resort surgical intervention** for refractory PPH - Should only be performed after failure of medical management (all uterotonics) and conservative surgical options (uterine tamponade, uterine artery ligation, B-Lynch suture) - **Too aggressive** as the immediate next step when second-line uterotonics haven't been tried *Expectant management* - **Completely inappropriate** for severe PPH with hemodynamic instability (hypotension, tachycardia) - Ongoing bleeding from uterine atony requires **immediate aggressive intervention** - Delays increase risk of hypovolemic shock, DIC, maternal morbidity, and mortality *IV tranexamic acid* - **Antifibrinolytic agent** that inhibits plasminogen activation, promoting clot stability - WHO recommends administration **within 3 hours** of PPH onset as an adjunct therapy - While useful in PPH management, it does **not address uterine atony** (the primary cause indicated by soft uterus) - Should be given **in addition to uterotonics**, not as a substitute for definitive management of atony

Question 189: A G2 P1 - 29-year-old female delivered a baby, but the baby died within 48 hours due to medical reasons. What drug will you advise to stop breast milk secretion?

A. None of the options
B. Ergot alkaloids
C. Cabergoline (Correct Answer)
D. Both B & C

Explanation: ***Cabergoline*** - **Cabergoline** is a **non-ergot dopamine agonist** that effectively inhibits pituitary prolactin secretion, leading to the suppression of lactation. - It works by acting on **D2 dopamine receptors** in the pituitary gland, thereby preventing milk secretion after delivery. - It is the **preferred first-line agent** for lactation suppression due to its superior efficacy, better tolerability, longer half-life (allowing single or twice-daily dosing over 2 days), and lower side effect profile. *None of the options* - This option is incorrect because there are specific pharmacological agents available and recommended for **lactation suppression** in such circumstances. - **Cabergoline** is a well-established and commonly used drug for this purpose. *Ergot alkaloids* - While **bromocriptine** (an ergot-derived dopamine agonist) was historically used for lactation suppression, it is no longer preferred. - **Cabergoline** has largely replaced bromocriptine due to better tolerability, longer half-life, less frequent dosing, and fewer side effects (bromocriptine causes more nausea, vomiting, and orthostatic hypotension). - Note: **Cabergoline itself is a non-ergot dopamine agonist**, making it pharmacologically distinct from ergot alkaloids. *Both B & C* - This option is incorrect because **cabergoline is not an ergot alkaloid**—it is a non-ergot dopamine agonist. - While bromocriptine (an ergot derivative) can suppress lactation, **cabergoline alone** is the preferred choice with superior efficacy and safety profile. - Combining or equating these agents is not standard clinical practice.

Question 190: What are the criteria for administering Anti-D immunoglobulin postpartum in an Rh-negative female?

A. DCT positive, Baby Rh +ve
B. DCT negative, Baby Rh +ve (Correct Answer)
C. DCT negative, Baby Rh -ve
D. DCT positive, Baby Rh -ve

Explanation: ***DCT negative, Baby Rh +ve*** * The mother is **Rh-negative** and needs Anti-D immunoglobulin if her baby is **Rh-positive** to prevent sensitization. * A **negative Direct Coombs Test (DCT)** indicates that the mother has not yet developed antibodies against the baby's Rh-positive red blood cells, making Anti-D administration effective for prevention. * *DCT positive, Baby Rh +ve* * If the **DCT is positive**, it means the mother has already formed **antibodies** against the baby's Rh-positive red blood cells (sensitization has occurred). * In this scenario, administering Anti-D immunoglobulin would be **ineffective** as the immune response has already begun. * *DCT negative, Baby Rh -ve* * If the baby is **Rh-negative**, there is no risk of Rh sensitization for an Rh-negative mother. * Therefore, **Anti-D immunoglobulin is not necessary** in this situation. * *DCT positive, Baby Rh -ve* * A **positive DCT** in an Rh-negative mother implies sensitization has occurred, but it would not be due to an Rh-negative baby. * Administering Anti-D immunoglobulin would be **ineffective** and unnecessary if the baby is Rh-negative.

Practice by Chapter

Normal Puerperium

Practice Questions

Lactation and Breastfeeding

Practice Questions

Postpartum Complications

Practice Questions

Postpartum Depression and Psychiatric Disorders

Practice Questions

Contraception After Delivery

Practice Questions

Postpartum Infections

Practice Questions

Secondary Postpartum Hemorrhage

Practice Questions

Recovery After Cesarean Delivery

Practice Questions

Postpartum Exercise and Rehabilitation

Practice Questions

Follow-up and Future Pregnancy Planning

Practice Questions

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