Postpartum Care — MCQs

Postpartum Care Indian Medical PG Practice Questions and MCQs

Question 201: What is the first line of treatment for mastitis in a lactating mother?

A. Ceftriaxone
B. Ampicillin
C. Cefazolin
D. Penicillinase-resistant penicillin (Correct Answer)

Explanation: ***Penicillinase-resistant penicillin*** - **Penicillinase-resistant penicillins** (e.g., dicloxacillin, flucloxacillin, cloxacillin) are considered **first-line treatment** for lactational mastitis in most guidelines. - They effectively target **penicillinase-producing *Staphylococcus aureus***, the most common causative organism in puerperal mastitis. - These antibiotics are **safe for lactating mothers** and do not require cessation of breastfeeding. - **Clinical note:** Continued breastfeeding or milk expression is essential alongside antibiotic therapy to prevent abscess formation. *Cefazolin* - **Cefazolin** (and its oral equivalent cephalexin) is a first-generation cephalosporin that is also considered **acceptable first-line therapy** for mastitis. - It provides good coverage against *Staphylococcus aureus* and is particularly useful in patients with **non-anaphylactic penicillin allergy**. - While both cefazolin and penicillinase-resistant penicillins are appropriate choices, traditional teaching emphasizes the penicillinase-resistant penicillins as the primary first-line agent. *Ceftriaxone* - **Ceftriaxone** is a third-generation cephalosporin with **broad-spectrum coverage** including gram-negative bacteria. - It is **not indicated as first-line** for uncomplicated community-acquired mastitis where *Staphylococcus aureus* is the primary pathogen. - Reserved for severe infections, treatment failures, or when broader coverage is needed. *Ampicillin* - **Ampicillin** is a penicillin-class antibiotic but is **NOT penicillinase-resistant**. - Since most strains of *Staphylococcus aureus* (approximately 80-90%) produce **β-lactamase (penicillinase)**, ampicillin would be ineffective in most cases of mastitis. - This makes it an **inappropriate choice** for empiric first-line treatment.

Question 202: Which of the following conditions is least likely to cause secondary postpartum haemorrhage?

A. Placenta previa (Correct Answer)
B. Endometritis
C. Polyp
D. Retained bits of placenta

Explanation: ***Placenta previa*** - **Placenta previa** is a condition where the placenta partially or totally covers the mother's cervix, typically causing **antepartum hemorrhage** (bleeding before birth) or **primary postpartum hemorrhage** (bleeding within 24 hours of birth) due to placental separation during labor or delivery. - It is **least likely** to cause secondary postpartum hemorrhage, which occurs 24 hours to 12 weeks after birth, as its direct bleeding risk is immediate. *Retained bits of placenta* - **Retained placental fragments** prevent the uterus from contracting effectively, leading to sustained bleeding. - This is a common and direct cause of **secondary postpartum hemorrhage**. *Endometritis* - **Endometritis**, an infection of the uterine lining, often presents with fever, pain, and abnormal bleeding, including secondary postpartum hemorrhage. - The inflammation and infection can interfere with uterine involution and healing, leading to delayed bleeding. *Polyp* - Uterine **polyps**, particularly endometrial polyps, can cause irregular or heavy uterine bleeding. - While not typically a dramatic gush, a polyp can be a source of persistent or recurrent bleeding that manifests as **secondary postpartum hemorrhage**.

Question 203: Most common cause of secondary PPH is :

A. Retained placenta (Correct Answer)
B. Cervical tear
C. Uterine atony
D. Vaginal laceration

Explanation: ***Retained placenta*** - Retained placental tissue prevents the uterus from contracting effectively, leading to continued bleeding after delivery. - While it's a common cause of primary PPH as well, it often presents as a secondary PPH when small fragments remain and later detach or become infected. *Uterine atony* - This is the **most common cause of primary PPH**, occurring within 24 hours of delivery due to the uterus failing to contract. - It is less likely to be the primary cause of secondary PPH unless there's a delayed presentation. *Vaginal laceration* - Lacerations of the vagina usually present as **primary PPH**, with bright red blood despite a well-contracted uterus. - While bleeding can persist, it's not the most common cause of delayed, secondary PPH. *Cervical tear* - Cervical tears also typically cause **primary PPH**, characterized by continuous bleeding immediately after delivery. - Similar to vaginal lacerations, while continuous bleeding can occur, it's not the most common etiology for secondary PPH.

Question 204: Commonest cause for puerperal sepsis is :

A. Gonococci
B. Staphylococci
C. Streptococci (Correct Answer)
D. Anaerobes

Explanation: ***Streptococci*** - **Streptococci**, particularly **Group A Streptococcus (GAS/Streptococcus pyogenes)** and **Group B Streptococcus (GBS)**, are the **most common causative organisms** of puerperal sepsis in modern obstetric practice. - **Group A Streptococcus** causes severe, rapidly progressive puerperal sepsis with high morbidity and is the **leading bacterial cause** historically and currently. - **Group B Streptococcus** commonly colonizes the genital tract and frequently causes postpartum endometritis and sepsis. - These organisms can invade through the **placental site** and **cervical/vaginal lacerations** during delivery. *Anaerobes* - **Anaerobic bacteria** (e.g., *Bacteroides fragilis*, anaerobic streptococci) are important pathogens but typically cause **polymicrobial infections** rather than being the single most common cause. - They thrive in devitalized tissue and are often isolated **in combination with aerobic organisms**. - While significant in complicated cases, they are **not the most common single cause** in contemporary practice. *Staphylococci* - **Staphylococcus aureus** typically causes **wound infections** (cesarean section sites), **mastitis**, and occasionally toxic shock syndrome. - They are less commonly the primary cause of intrauterine puerperal sepsis compared to streptococci. *Gonococci* - **Neisseria gonorrhoeae** causes **pelvic inflammatory disease (PID)** and can lead to postpartum endometritis in untreated cases. - It is **not a common cause** of puerperal sepsis as most pregnant women are screened and treated during antenatal care. - More associated with **sexually transmitted infections** than typical postpartum infections.

Question 205: At what point does the uterus return to being classified as a pelvic organ after pregnancy?

A. 2 weeks
B. 4 weeks
C. 12 weeks
D. 6 weeks (Correct Answer)

Explanation: ***6 weeks*** - By **6 weeks postpartum**, the uterus typically has undergone significant involution, returning to its **pre-pregnancy size and weight**. - At this point, it is no longer palpable abdominally and descends back into the **pelvic cavity**, classifying it again as a pelvic organ. *4 weeks* - While significant involution occurs by 4 weeks, the uterus is generally still slightly enlarged and might be palpable just above the **symphysis pubis**. - It has not fully returned to its non-pregnant size or its definitive location as a purely pelvic organ at this stage. *12 weeks* - By 12 weeks postpartum, the uterus has long since returned to its pre-pregnancy size and relocated to the **pelvic cavity**; this period is past the typical time for reclassification. - Involution is generally complete earlier than 12 weeks. *2 weeks* - At 2 weeks postpartum, the uterus is still undergoing rapid **involution** but is significantly larger than its pre-pregnancy size. - It remains palpable abdominally, usually midway between the **umbilicus** and the pubic symphysis, and has not yet descended back into the pelvic cavity.

Question 206: Which organism causes puerperal sepsis?

A. Group A beta hemolytic streptococci (Correct Answer)
B. CMV
C. Toxoplasma gondii
D. Group B beta hemolytic streptococci

Explanation: ***Group A beta hemolytic streptococci*** - **Group A Streptococcus (GAS)**, specifically *Streptococcus pyogenes*, is the **classic and most important cause of puerperal sepsis** (puerperal fever). - Historically, GAS was responsible for devastating epidemics of puerperal fever in maternity wards before the introduction of antiseptic practices by Ignaz Semmelweis. - GAS causes severe, rapidly progressive postpartum infections with **high morbidity and mortality** if untreated. - Clinically presents with fever, severe uterine tenderness, and can progress to **toxic shock syndrome** and septicemia. *Group B beta hemolytic streptococci* - **Group B Streptococcus (GBS)**, *Streptococcus agalactiae*, can cause postpartum endometritis and maternal infections. - However, GBS is **more commonly associated with neonatal sepsis** rather than being the primary cause of classic puerperal sepsis. - While it can colonize the genital tract and cause infection, it is not the historical or most severe cause of puerperal fever. *CMV* - **Cytomegalovirus (CMV)** is a viral infection that causes congenital infections when transmitted in utero. - It is not a bacterial cause of **puerperal sepsis**, which is primarily a bacterial postpartum infection. *Toxoplasma gondii* - **Toxoplasma gondii** is a parasite causing toxoplasmosis, which can lead to congenital abnormalities. - It is not associated with **puerperal sepsis**, which is a bacterial infection of the postpartum period.

Question 207: Maximum maternal mortality during peripartum period occurs at -

A. Last trimester
B. During labor
C. Immediate post-partum (Correct Answer)
D. Delayed post-partum

Explanation: ***Immediate post-partum*** - The **immediate postpartum period** (first 24 hours after birth) is considered the most critical time for maternal mortality, accounting for approximately **45-50% of all maternal deaths**. - Primary causes include **postpartum hemorrhage** (leading cause, responsible for ~25% of maternal deaths globally), **eclampsia**, and **amniotic fluid embolism**. - This phase involves significant physiological changes and potential complications arising directly from the birthing process, with risks being highest in the first few hours after delivery. *Last trimester* - While the **last trimester** carries risks such as pre-eclampsia, gestational diabetes, and thrombosis, the overall mortality rate is lower compared to the immediate postpartum period. - Many of the complications arising in late pregnancy are either manageable with proper antenatal care or culminate in critical events during or just after delivery. *During labor* - **Maternal mortality during labor** can occur due to complications like obstructed labor, uterine rupture, or severe pre-eclampsia. However, modern obstetric care with active management aims to identify and manage these issues promptly. - Many *intrapartum* complications often lead to adverse outcomes that extend into the immediate postpartum phase, where the majority of deaths are recorded. *Delayed post-partum* - The **delayed postpartum period** (from 24 hours up to 6 weeks after birth) still carries risks such as infections (puerperal sepsis), venous thromboembolism, and peripartum cardiomyopathy, but the incidence of acute, life-threatening events is significantly lower than in the immediate postpartum period. - Mortalities during this period are often related to complications that develop or worsen over time, rather than acute events directly from birth.

Question 208: 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 209: What is the primary use of prophylactic methergin?

A. None of the options
B. Induction of labour
C. Induction of abortion
D. To stop excess bleeding from uterus (Correct Answer)

Explanation: ***To stop excess bleeding from uterus*** - **Methergin (Methylergonovine)** is an **ergot alkaloid** that causes strong contractions of the **uterus**. - Its primary prophylactic use is to **prevent or treat postpartum hemorrhage** by contracting the uterus and compressing blood vessels. *Induction of labour* - **Methergin** is generally **contraindicated for labor induction** as its potent, sustained contractions can cause **hypertonic uterine dysfunction** and fetal distress. - **Oxytocin** is the preferred agent for **labor induction** due to its more physiological contraction pattern. *Induction of abortion* - While methergin can cause uterine contractions, it is **not the primary agent for abortion induction**. - **Prostaglandins (e.g., misoprostol)** and other pharmacological agents are typically used in combination for **medical abortion**. *None of the options* - This option is incorrect because **stopping excess uterine bleeding** is indeed a primary use of prophylactic methergin, particularly in the postpartum period. - The other options describe situations where methergin is either not indicated or is a secondary/contraindicated choice.

Question 210: 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.

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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