Podcast
Questions and Answers
What is the primary change of the external os in multiparous females?
What is the primary change of the external os in multiparous females?
Lochia alba lasts for an average of 10-20 days post-delivery.
Lochia alba lasts for an average of 10-20 days post-delivery.
False
At what average time does menstruation return in partially or non-breastfeeding females post-delivery?
At what average time does menstruation return in partially or non-breastfeeding females post-delivery?
6-8 weeks
The cervix opens into a ______ shape after childbirth in nulliparous women.
The cervix opens into a ______ shape after childbirth in nulliparous women.
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Match the following components of lochia with their characteristics:
Match the following components of lochia with their characteristics:
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What is the most common cause of subinvolution of the uterus?
What is the most common cause of subinvolution of the uterus?
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Breast milk production is not dependent on prolactin.
Breast milk production is not dependent on prolactin.
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What is the role of oxytocin in breastfeeding?
What is the role of oxytocin in breastfeeding?
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Colostrum contains more nutrients than mature breast milk, except for ______.
Colostrum contains more nutrients than mature breast milk, except for ______.
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Match the hormone with its effect during breastfeeding:
Match the hormone with its effect during breastfeeding:
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Which of the following is NOT a contraindication for VBAC?
Which of the following is NOT a contraindication for VBAC?
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A previous vaginal delivery is considered a bad prognostic marker for VBAC.
A previous vaginal delivery is considered a bad prognostic marker for VBAC.
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What is the main consideration for performing a classical cesarean section in the case of carcinoma cervix?
What is the main consideration for performing a classical cesarean section in the case of carcinoma cervix?
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The condition of _______ is a relative contraindication for VBAC where repeat c-section is preferred.
The condition of _______ is a relative contraindication for VBAC where repeat c-section is preferred.
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Match the following terms with their descriptions:
Match the following terms with their descriptions:
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Which of the following are absolute contraindications for breastfeeding? (Select all that apply)
Which of the following are absolute contraindications for breastfeeding? (Select all that apply)
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COVID-19 infection is a contraindication for breastfeeding.
COVID-19 infection is a contraindication for breastfeeding.
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What is the most common site for post-partum endometritis?
What is the most common site for post-partum endometritis?
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The primary risk factor for post-partum endometritis is __________.
The primary risk factor for post-partum endometritis is __________.
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Match the condition with its key feature:
Match the condition with its key feature:
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What is the recommended duration of heparin therapy if thrombophlebitis is present?
What is the recommended duration of heparin therapy if thrombophlebitis is present?
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Breast engorgement is a common cause of fever in breastfeeding females.
Breast engorgement is a common cause of fever in breastfeeding females.
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Which nerve is most commonly injured after cesarean section?
Which nerve is most commonly injured after cesarean section?
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If a patient experiences burning sensation, numbness, and tingling in the upper, outer thigh, the affected nerve is the __________.
If a patient experiences burning sensation, numbness, and tingling in the upper, outer thigh, the affected nerve is the __________.
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Match the following symptoms with the corresponding affected nerves:
Match the following symptoms with the corresponding affected nerves:
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What is the contraceptive of choice during the puerperium period for breastfeeding females?
What is the contraceptive of choice during the puerperium period for breastfeeding females?
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Lactational amenorrhea is due to increased levels of GNRH.
Lactational amenorrhea is due to increased levels of GNRH.
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What is the normal range for leukocytosis in the first few days post-delivery?
What is the normal range for leukocytosis in the first few days post-delivery?
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Immediately after delivery, a woman's weight loss is approximately _____ kg.
Immediately after delivery, a woman's weight loss is approximately _____ kg.
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Match the postpartum parameter with its normal return timeline:
Match the postpartum parameter with its normal return timeline:
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What is the average weight of the uterus immediately after delivery?
What is the average weight of the uterus immediately after delivery?
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Involution of the uterus is faster in multiparous women than in nulliparous women.
Involution of the uterus is faster in multiparous women than in nulliparous women.
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What is the recommendation for the first postnatal visit according to ACOG?
What is the recommendation for the first postnatal visit according to ACOG?
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The fundal height decreases by ______ cm/day after 24 hours.
The fundal height decreases by ______ cm/day after 24 hours.
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Match the duration after delivery with the corresponding weight of the uterus:
Match the duration after delivery with the corresponding weight of the uterus:
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Which of the following is an absolute contraindication for internal podalic version?
Which of the following is an absolute contraindication for internal podalic version?
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Transient tachypnea of the newborn is a complication that can arise after a cesarean section.
Transient tachypnea of the newborn is a complication that can arise after a cesarean section.
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What is the most common anesthesia method used during labor?
What is the most common anesthesia method used during labor?
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____ is a hormone often used to induce labor.
____ is a hormone often used to induce labor.
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Match the following indications with the type of anesthesia used:
Match the following indications with the type of anesthesia used:
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Study Notes
Subinvolution
- Most common cause of subinvolution: retained placental fragments
- Other causes: incompletely remodeled spiral artery, infection
- Clinical findings include: excessive uterine bleeding, prolonged lochia
- Bimanual examination: uterus is bigger than expected
- Investigations include: pelvic ultrasound
- Management of retained products: uterotonic (DOC) followed by gentle curettage
- Excessive curettage can lead to Asherman syndrome
Breastfeeding
- Prolactin levels are highest during the third trimester and decline after delivery
- Breast milk production depends on prolactin
- First stimulus for milk production is decreased estrogen after placental delivery
- Ejection reflex relies on oxytocin
Colostrum
- Contains more nutrients than mature breast milk, except for KFC (likely a typo or abbreviation).
- Contains potassium, fat, carbohydrates, and calcium.
Labor and Puerperium: Changes
- Lower uterine segment: Becomes isthmus, dilates to 10 cm during delivery, then closes
- External os: Pinpoint in nulliparous women, transverse slit-like in multiparous women
- Endometrial changes: Superficial decidual sloughing/shedding after delivery, which is called lochia
- Lochia duration: 6 weeks
- Lochia components: decidua and blood
- Lochia sequences: Rubra (4-5 days), Serosa (5-10 days), Alba (≥ 10 days)
- Average duration of lochia: 24-36 days
- Placental site involution: Site of placental attachment is the most common site for endometriosis
Ovarian Function
- In non-breastfeeding or partially-breastfeeding women:
- Menstruation returns by 6-8 weeks
- Ovulation returns by 7 weeks
- Earliest ovulation can occur by 28 days
Cesarean Section: VBAC
- Previous history of: classical C-section, uterine rupture, myomectomy or hysterotomy, T-shaped incision, contracted pelvis, home delivery, cephalopelvic disproportion are contraindications
- Repeat C-section preferred if: macrosomia, post-term pregnancy, malpresentation (breech)
- Prognostic marker for VBAC success: Previous history of vaginal delivery
- Bad prognostic marker for VBAC success: history of puerperal sepsis or endometritis after previous C-section
- Monitoring during VBAC: maternal pulse rate, CTG monitoring, uterine scar tenderness
Cesarean Section: Classical
- Indications:
- Difficult access to lower uterine segment (carcinoma cervix, dense adhesion, placenta previa with large blood vessels, very early preterm C-section, perimortem C-section)
Labor and Puerperium Management
- Thrombophlebitis: Continue heparin until 48 hours after patient is afebrile if no evidence of thrombophlebitis, continue for 6 weeks if present
- Fever in breastfeeding females:
- Cause: breast engorgement
- Frequency: Rarely
- Temperature: ≥ 39°C
- Duration: < 24 hours
Obstetric Neuropathy: Vaginal Delivery
- Lateral cutaneous nerve of the thigh: m/c nerve injured, causes burning sensation, numbness, and tingling in the upper, outer thigh and lateral hip
- Femoral nerve injury: m/c nerve injured, causes quadriceps muscle weakness (adductors spared), sensory loss over anterior and medial thigh
- Peroneal nerve injury: Causes foot drop, prolonged squatting, or palmar pressure during fundal pressure
- Most common nerve injured after cesarean section: ilioinguinal nerve and iliohypogastric nerve
Puerperium: Contraindications for Breastfeeding
- Absolute contraindications: Galactosemia/Lactose intolerance
- Relative contraindications: IV drug abuse, active herpes lesion in breast, untreated active pulmonary TB, undergoing breast cancer treatment
- Not a contraindication: HIV (in India), COVID-19 infection, mastitis/breast abscess, HepB +ve mother if baby has received immunoprophylaxis
Puerperial Pathologies: Post-partum Endometritis
- Most common site: Placental site
- Risk factors: C-section, history of chorioamnionitis, prolonged rupture of membranes
- Management: Broad spectrum antibiotics
Puerperial Pathologies: Septic Pelvic Thrombophlebitis
- Presentation: Fever, subinvolution of uterus, uterine tenderness, foul-smelling lochia
- Involvement: Ovarian vein (right > left)
- Pelvic examination: Cord-like structure
- Blood culture: Negative (localized infection)
- MRI/CT: Thrombosed vein may be seen
- Features: Broad-spectrum antibiotic use has no effect, clinical diagnosis is necessary
Puerperium: Contraception
- Oral contraceptives are contraindicated in the first 21 days after delivery due to risk of venous thrombosis
- Contraceptive of choice during breastfeeding: POP > IUCD
- Lactational amenorrhea is effective contraception, but has a 4% risk of pregnancy per year
Puerperium: Other Changes
- Marked leucocytosis ( ≤ 25,000/μL after delivery): Increase in granulocytes, relative lymphopenia, absolute eosinopenia, marked thrombocytosis
- Urinary retention
- Weight loss: 5-6 kg immediately, 2-3 kg due to postpartum diuresis
- Decrease in Hb and hematocrit values
- High fibrinogen in the first week
- Sodium and potassium retention, which may require postpartum diuretics
- Initial 24-48 hours: High cardiac output, risk of heart failure
- Blood volume returns to normal within 1 week, cardiac output and heart rate return to normal in 10 days, GFR returns to normal within 2 weeks, dilated ureter and renal pelvis return to normal within 2-8 weeks
After Pain
- Seen in multiparous females
- Cause: Uterine contractions due to oxytocin
- Increases with breastfeeding
- Decreases by day 3
- Persistent and severe pain may indicate postpartum infection
Labor and Puerperium: Miscellaneous Points
- Induction of labor is possible in patients with a previous C-section, but mechanical methods for cervical ripening should be used before oxytocin
- External podalic version is relatively contraindicated, and internal podalic version is absolutely contraindicated in patients with a previous C-section
- Contracted pelvis is a recurrent reason for cesarean section
- Past history of cephalopelvic disproportion is not a contraindication for VBAC
- Increased complications after cesarean section: Transient tachypnea of newborn, postpartum endometritis
Anesthesia: Methods and Indications
- Most common anesthesia: Spinal anesthesia
- Indications for epidural anesthesia: heart disease, pre-eclampsia (PIH)
- Indications for general anesthesia: fetal distress, convulsions, maneuvers requiring hand insertion into uterus, uterine inversion, manual removal of placenta
Puerperium vs. Fourth Trimester
- Puerperium: Period after childbirth until 6 weeks after delivery
- ACOG recommends:
- Initial postnatal visit: 3 weeks
- Final postnatal visit: 12 weeks
- Additional visits as needed between these visits
Changes During Puerperium: Uterus
- Immediately after delivery: Uterus is just below the level of the umbilicus, corresponding to 20 weeks POG, with the consistency of a cricket ball, weighs 1000gm
- After 1 week: Uterus is midway between umbilicus and pubic symphysis, weighs 500gm
- After 2 weeks: Uterus is not palpable, weighs 300gm
- After 4 weeks: Involution is complete, weighs 100gm
- Involution is faster in nulliparous than multiparous women
- Sonographically, the uterus and endometrium return to the pre-pregnant state by eight weeks
- GOI recommends:
- 1st visit: 1st day
- 2nd visit: 3rd day
- 3rd visit: 7th day
- 4th visit: 6 weeks
- Fundal height decreases by 1.25 cm/day after 24 hours
- This summary reflects the provided information. Further exploration of the underlying context or clarification of abbreviations and short forms is recommended to provide a more comprehensive understanding.
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Description
Test your knowledge on subinvolution, breastfeeding, and related medical conditions in obstetrics and gynecology. This quiz covers topics such as the management of retained placental fragments, the role of hormones in lactation, and the nutritional content of colostrum. Prepare to assess your understanding of critical concepts in maternal health.
