Puerperium Quiz
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Questions and Answers

What is the duration of moderate pain after vaginal delivery?

  • 2 days (correct)
  • 1 day
  • 4 days
  • 3 days

    • Which type of lochia has a yellow color?

  • Lochia cruenta
  • Lochia rubra
  • Lochia serosa
  • Lochia alba (correct)

    • What is the primary cause of afterpain in multiparas?

  • Prolactin hormone release
  • Oxytocin release during breastfeeding
  • Uterine contractions at interval (correct)
  • Tonic uterine contractions

    • What percentage of women still have lochia at week 6 postpartum?

    <p>15%</p> Signup and view all the answers

    What is the primary reason for the absence of ovulation immediately postpartum?

    <p>Prolactin hormone inhibits GnRH release</p> Signup and view all the answers

    What is the characteristic of lochia serosa?

    <p>Brownish-red color and decreasing amount</p> Signup and view all the answers

    What is the primary cause of afterpain in primiparas?

    <p>Tonic uterine contractions</p> Signup and view all the answers

    What is the duration of lochia in most women?

    <p>5 weeks</p> Signup and view all the answers

    What is the effect of breastfeeding on the uterus?

    <p>Contraction of the uterus</p> Signup and view all the answers

    What is the characteristic of lochia rubra?

    <p>Red color and variable duration</p> Signup and view all the answers

    What is the approximate weight of the uterus immediately after delivery?

    <p>1000g</p> Signup and view all the answers

    By what time has the uterus usually returned to the true pelvis?

    <p>2 weeks postpartum</p> Signup and view all the answers

    What is the characteristic of the external os after childbirth?

    <p>A large, transverse, stellate slit</p> Signup and view all the answers

    By what time has the vaginal epithelium returned to a normal non-pregnant state?

    <p>6-10 weeks</p> Signup and view all the answers

    What is the characteristic of the perineum by 1-2 weeks postpartum?

    <p>Swelling and engorgement are completely gone</p> Signup and view all the answers

    What is the approximate time frame for the uterus to return to a non-pregnant state?

    <p>6 weeks postpartum</p> Signup and view all the answers

    What is the characteristic of the cervix after childbirth?

    <p>The external os is closed and cannot be easily introduced by a finger</p> Signup and view all the answers

    What is the characteristic of the vagina after childbirth?

    <p>It returns to a non-pregnant state but never to the nulliparous state</p> Signup and view all the answers

    By what time has the increased vascularity and edema of the vagina resolved?

    <p>3 weeks postpartum</p> Signup and view all the answers

    What is the definition of the puerperium period?

    <p>The time from the delivery of the placenta to the first few weeks after delivery</p> Signup and view all the answers

    What percentage of gestational weight gain is typically lost in the first six weeks after delivery?

    <p>One-half</p> Signup and view all the answers

    What is the primary factor in determining when a woman can return to her pre-pregnant abdominal wall state?

    <p>Exercise</p> Signup and view all the answers

    What is the typical time frame for physical readiness to resume sexual intercourse after delivery?

    <p>3 weeks</p> Signup and view all the answers

    What is the primary benefit of pelvic floor rehabilitation during the postpartum period?

    <p>Prevents and manages pelvic organ prolapse and urinary incontinence</p> Signup and view all the answers

    What is the recommended duration of moderate-intensity exercise per day during the postpartum period?

    <p>20 to 30 minutes</p> Signup and view all the answers

    What is the primary role of a women's health physiotherapist during the postnatal period?

    <p>Implements physical therapy to improve health outcomes</p> Signup and view all the answers

    What is the primary benefit of postnatal exercise in terms of mental health?

    <p>Prevents depressive disorders</p> Signup and view all the answers

    What is the primary outcome of incorporating physical therapy into postpartum care?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of manual therapies in postpartum care?

    <p>Pain management</p> Signup and view all the answers

    What is the primary benefit of postnatal exercise in terms of lactation?

    <p>Stimulates lactation</p> Signup and view all the answers

    What percentage of women who are not breastfeeding return to their periods within 36 weeks?

    <p>50-75%</p> Signup and view all the answers

    What is the primary reason for feeding the baby every 2-3 hours to stimulate milk production?

    <p>To stimulate milk production and promote lactation</p> Signup and view all the answers

    What is the approximate weight loss during the puerperium due to contraction of the uterus, loss of lochial fluid, and loss of excess fluids?

    <p>2-7 kg</p> Signup and view all the answers

    What is the primary reason for initiating breastfeeding as soon as possible after delivery?

    <p>To ensure the baby receives colostrum</p> Signup and view all the answers

    What is the contraindication for breastfeeding in women with active herpes simplex virus?

    <p>The virus can be transmitted to the baby through breast milk</p> Signup and view all the answers

    What is the primary function of colostrum in the first 2-4 days after delivery?

    <p>To provide immune factors to the baby</p> Signup and view all the answers

    What is the mean weight loss from the delivery of the fetus, placenta, and amniotic fluid?

    <p>6 kg</p> Signup and view all the answers

    Why is lactation possible as early as 16 weeks' gestation?

    <p>The breasts undergo changes during pregnancy</p> Signup and view all the answers

    What is the primary reason breastfeeding is not automatic or easy?

    <p>Breastfeeding requires learning and practice</p> Signup and view all the answers

    What is the primary contraindication for breastfeeding in women with HIV?

    <p>The virus can be transmitted to the baby through breast milk</p> Signup and view all the answers

    Study Notes

    Normal Puerperium

    • Definition: The time from the delivery of the placenta through the first few weeks after delivery (6 weeks postpartum)
    • Importance: By 6 weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non-pregnant state

    Uterus

    • Size: Immediately after delivery, the uterus can be palpated at or near the umbilicus, reducing to 500g after 1 week, 300g at the end of 2 weeks, and 100g or less thereafter
    • Weight: Most of the reduction in size and weight occurs in the first 2 weeks
    • Tissues revert to a non-pregnant state, but never return to the nulliparous state

    Cervix

    • The external os is closed to the extent that a finger could not be easily introduced
    • The external os never resumes its pre-gravid shape; it becomes a large, transverse, stellate slit after childbirth

    Vagina

    • Shrinks to a non-pregnant state
    • Resolution of the increased vascularity and edema occurs by 3 weeks
    • The vaginal epithelium appears atrophic on smear, restored by weeks 6-10
    • Tissues revert to a non-pregnant state, but never return to the nulliparous state

    Perineum

    • Swelling and engorgement are completely gone within 1-2 weeks
    • The gapping of the vulva that occurs during vaginal delivery remains for 2-3 weeks, then gradually disappears, but never returns to the pre-pregnancy state
    • Muscle tone may or may not return to normal, depending on the extent of injury

    Afterpain

    • Duration: Moderate pain for 2 days, mild pain by the 3rd day postpartum
    • Causes:
      • Multipara: The uterus contracts vigorously at intervals
      • Primiparas: The uterus tonically contracts
      • Infant suckling (breastfeeding): Oxytocin release → uterine contraction → afterpain

    Lochia

    • Duration: Variable, lasts about 5 weeks, with 15% of women having lochia at week 6 postpartum
    • Types:
      • Lochia rubra: Red, variable duration
      • Lochia serosa: Brownish-red, more watery consistency, decreases in amount
      • Lochia alba: Yellow

    Ovulation and Menstruation

    • There is no ovulation immediately postpartum due to prolactin hormone inhibiting gonadotrophin releasing hormone (GnRH) release from the hypothalamus
    • Ovulation is restored after a duration depending on whether the woman is breastfeeding or not
    • Menstrual cycles resume when ovulation is restored

    Breastfeeding

    • Changes to the breast that prepare for breastfeeding occur throughout pregnancy
    • Lactation can occur by 16 weeks' gestation
    • Colostrum: High in protein and immune factors, first 2-4 days after delivery
    • Mature milk: Contains all the necessary nutrients, changes throughout the period of breastfeeding
    • Initiation: Should be initiated as soon as possible after delivery, feeding every 2-3 hours to stimulate milk production

    Contraindications to Breastfeeding

    • Alcohol use and street drugs
    • Certain medications
    • Active untreated tuberculosis (TB)
    • Infections: HIV, Cytomegalovirus, and hepatitis B virus
    • Women with active herpes simplex virus
    • An infant with galactosemia
    • Mother undergoing breast cancer treatment

    Physiologic Weight Loss

    • Mean weight loss from delivery of the fetus, placenta, and amniotic fluid is 6 kg
    • Additional loss of 2 to 7 kg during the puerperium due to contraction of the uterus, loss of lochial fluid, and loss of excess intra- and extracellular fluid
    • Approximately one-half of gestational weight gain is lost in the first six weeks after delivery, with a slower rate of loss through the first six months postpartum

    Abdominal Wall

    • Remains soft with poor tone for many weeks
    • Return to a pre-pregnant state depends greatly on exercise

    Sexual Intercourse

    • May resume when:
      • Red bleeding ceases
      • Vagina and vulva are healed
      • Physically comfortable
      • Emotionally ready
    • Physical readiness usually takes ~3 weeks

    Concerns - Puerperal Period

    • Physical activity and exercise during the postpartum period
    • Pelvic floor rehabilitation:
      • Prevent and manage pelvic organ prolapse
      • Prevent and manage urinary incontinence
      • Improve sexual function
    • Benefits of postnatal exercise:
      • Restores physical health
      • Improves sleep quality
      • Relieves stress
      • Prevention of depressive disorders
      • Reduced body weight
      • Stimulates lactation
      • Alleviates postnatal issues such as diastasis recti, urinary incontinence, pelvic organ prolapse, and pelvic girdle pain

    Role of Women's Health Physiotherapist

    • Physical therapy can improve health outcomes for new mothers in the postnatal period
    • Benefits:
      • Improve mood
      • Improve cardio-respiratory fitness
      • Promote weight loss
      • Reduce the risk of postpartum depression and anxiety
      • Enhance psychological well-being
      • Improve sexual health and sexual dysfunction
      • Lead to better outcomes assessing quality of life

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    Description

    This quiz covers the definition and importance of puerperium, including the changes that occur in the body after childbirth. It also discusses the size of the uterus during this period.

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