Normal Puerperium

All are true of involution of uterus after childbirth except

A. At the end of 6 weeks, its measurement is almost similar to that of the nonpregnant state
B. The external os never reverts back to the nulliparous state
C. The placental site contracts rapidly and becomes normal within a week
D. The contour of the cervix takes a longer time to regain

Not true of Lochia is

A. Discharge of lochia alba beyond 3 weeks suggests local genital lesion
B. Persistence of red lochia beyond one week might be an indicator of uterine subinvolution
C. Cholesterin crystals, fatty acids are part of lochia alba
D. Presence of bacteria in lochia serosa is pathognomonic of infection

Not true of normal puerperium is

A. Pronounced diuresis on the 2nd or 3rd day of the puerperium
B. A hypercoagulable state persists for 48 hours postpartum
C. Leukocytosis to the extent of 25,000/mm3 can appear
D. Cardiac output falls soon after delivery

Not true of Prolactin level after childbirth

A. If a mother does not breastfeed, prolactin levels usually reach nonpregnant levels by seven days postpartum
B. Prolactin levels don’t follow a circadian rhythm in breastfeeding mothers
C. Remain elevated for as long as the mother breastfeeds, even if she breastfeeds for years
D. Reach the level of 200 ng/mL in pregnant women at term

Lactogenesis is enhanced by all the following hormones except

A. Oxytocin
B. Thyroxine
C. Insulin,
D. Glucocorticoids

In short

  • Prolactin appears to be the single most important galactopoietic hormone. For maintenance of effective and continuous lactation, frequency of suckling (>8/24 hours) is essential.
  • Galactogogues: Metoclopramide (10 mg thrice daily) increases milk volume (60–100%) by increasing prolactin levels. Sulpiride (dopamine antagonist), domperidone and Intranasal oxytocin are also useful. 
  • Nonlactating women should practice some form of contraceptive measures after 3 weeks and the lactating women should start 3 months after delivery. Exclusive breastfeeding provides 98% contraceptive protection for 6 months.
  • In lactating women Progestin only pill may be a better choice for contraception.
  • Other progestins (DMPA, Levonorgestrel implants may be used. IUDs are also a satisfactory method irrespective of breastfeeding status.

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