Unit –X

QUESTIONS
Essays 10. Post partum haemorrhage
1. Post partum haemorrhage (Etiology, 11. Retained placenta
types, Pathophysiology, treatment, 12. Placenta accrete
nurses role, management of true post 13. puerperal pyrexia
partum haemorrhage) 14. Puerperal sepsis
15. Subinvolution
Short Notes 16. Phlegmasia alba dolens
2. Retained Placenta
3. Puerperal sepsis/pyrexia Give reason
4. Subinvolution of uterus  The normal vaginal flora causes
5. Breast complications during puerperium puerperal sepsis
6. Urinary complications Difference between
7. Psychological complications during  Primary PPH -
puerperium Secondary PPH
8. Thromboembolic disorders  Post partum blues -
9. Difficulties in Lactation and suppression post partum depression
of lactation

Definitions

ANSWER KEY
Essays Precipitate labour
1. Post partum Haemorrhage:- Others – Obesity, Previous
 Definition PPH, Age (> 40 yrs), Drugs –
 Types tocolytic drugs. MgSO4,
A) Primary Post partum haemorrhage Nefedipine
B) Secondary Post partum haemorrhage - Traumatic
 Primary Post partum haemorrhage - Retained tissues
Haemorrhage occurs within 24 - Blood coagulopathy
hours following the birth of the baby.  Diagnosis
There are two types  Prevention
1) Third stage haemorrhage:- Antenatal
Bleeding occurs before Intranatal
expulsion of placenta.  Management
2) True postpartum haemorrhage:- Placental site bleeding
Bleeding occurs subsequent to Traumatic bleeding
expulsion of placenta. Acutal management
 Causes (flow chart)  Secondary Post partum haemorrhage
- Atonic:- Haemorrhage occurs beyond 24hrs and
Grand multipara with in puerperium.
Over distension of the uterus  Causes
Malnutrition & anemia  Diagnosis
Ante partum haemorrhage  Management
Prolonged labour  Nursing Management
Anaesthesia
Initiation or augmentation of Short Notes
delivery 2. Retained Placenta
Malformation of the uterus  Definition
Uterine fibroid  Causes
Mismanaged third stage of  Diagnosis
labour  Management
Placenta Separated
 Unseparated 7. Psychological complications
Complicated during puerperium
 Complications  Risk factors
 Nursing Management  Puerperal blues
 Postpartum depression
3. Puerperal sepsis/pyrexia  Postpartum psychosis
 Definition  Management of each
 Predisposing factors  Nursing management
Antepartum factors
Intrapartum factors 8. Thromboembolic disorders
 Mode of infection  Deep vein thrombosis
 Clinical features
 Thrombophlebitis
Local infection
Uterine infection  Management
Spreading infection  Pulmonary embolus
 Investigation  Sign and symptoms
 Treatment  Diagnosis
General care  Management
Medical management
 Nursing management
Surgical management
 Nursing Management
9. Difficulties in Lactation and
4. Subinvolution of uterus suppression of lactation
 Definition - Difficulties of lactation
 Causes  Breastfeeding problems
 Clinical features  Low milk supply
 Management  Breast pain
 Nursing Management  Breast engorgement
 Inverted nipple
5. Breast complications during  Candidiasis
puerperium  Milk stasis
 Breast engorgement
Causes  Mastitis
Clinical features  Overactive let down
Treatment  Raynaud’s disease of the
 Cracked & Retracted nipple nipple
Definition  Infant health problems
Causes  Transmission of infection
Clinical features
 Transmission of drugs and
Treatment
 Acute mastitis toxins
Risk factors  Diet
Clinical features - Lactation suppression
Treatment Bromocriptine
 Breast abscess Mechanical methods
 Lactation failure
 Nursing Management 10. Postnatal exercises
Guidelines for postnatal exercises
6. Urinary complications  Purposes
 Urinary tract infection -Strengthen pelvic floor muscles to
 Retention of urine prevent incontinence
 Incontinence of urine
-Prevent back ache
 Suppression of urine
-Speed up restoration of body shape
 -Stimulate blood circulation and An infection of the genital tract
enhance appetite which occurs as a complication of
-Maintain vitality and increase delivery is termed puerperal sepsis.
15. Subinvolution
confidence
When the uterine involution is
 Types of exercises impaired or retarded it is called
-Pelvic floor exercises - Kegel subinvolution.
-Back and abdominal exercise 17. Phlegmasia alba dolens (White leg)
-Deep breathing exercises It is a clinicopathological condition
-Foot and ankle exercises usually caused by retrograde extension
-Pelvic tilting exercises of pelvic thrombophlebitis
-Head and shoulder raising
-Neck exercises
-Knee rolling
-Hip hitching and leg shortening
 Recommended post natal exercises:
 Brisk walking
 Swimming
 Aqua-aerobics
 Yoga
 Pilates
 Low-impact aerobic workouts
 Light weight training
 Cycling.
 Not recommended post natal
exercises (caesarean mother):
 hands-and-knees position
 swimming

Definitions
10. Post partum haemorrhage
It is related to the amount of blood
loss in excess of 500 ml following vaginal
birth and more than 1000 ml after CS
11. Retained placenta
It is said to be retained when the
placenta is not expelled out even 30 minutes
after the birth of the baby.
12. Placenta accreta
It is an extremely rare form in which
the placenta is directly anchored to the
myometrium partially or completely without
any intervening deciduas.
13. puerperal pyrexia
A rise of temperature reaching
100.4oF (38oC ) or more (measured orally)
on two separate occasions at 24 hours
apart(excluding first 24 hours ) within first
10 days following delivery is called
puerperal pyrexia.
14. Puerperal sepsis