Self-Assessment Questions (SAQs) for Study Session 3

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 3.1 (tests Learning Outcomes 3.1, 3.2 and 3.5)

You are talking to one of your co-health workers about the complications that can occur in the course of the puerperium. She has only just started her health worker training and is curious about the following terms and what their key symptoms are. What might you say to her about each of the following?

  • a.Late postpartum haemorrhage.
  • b.Puerperal sepsis and fever.
  • c.Mastitis.
  • d.Postpartum hypertension.
  • e.Postpartum depression.

Answer

  • a.Late postpartum haemorrhage (PPH) is heavy vaginal bleeding during the first week and up to six weeks after delivery. PPH can be life threatening and must be referred immediately. Most common causes include infection (endometritis) of the inner wall of the uterus, failure of the uterus to contract properly, sloughing (peeling away) of the placental bed, or bits of the placenta remaining in the uterus. A less common cause is molar pregnancy.
  • b.Puerperal sepsis is a widespread bacterial infection of the reproductive tract following childbirth. It can mostly be prevented by good hygiene during delivery. Fever indicates the possibility of sepsis, but it could also be due to urinary tract infection or infected wounds, HIV, malaria, typhoid, tetanus, meningitis, pneumonia, etc.
  • c.A hot red painful breast indicates mastitis, an inflammation of the breast due to bacterial infection. Women lactating are at a higher risk of puerperal mastitis if the baby does not suckle well and the breast is not emptied of milk. An abscess is another risk from breast infection, when pus collects in the infected tissue.
  • d.Postpartum hypertension is excessively high blood pressure in the postnatal period. Key symptoms are severe headache, convulsions (eclampsia), swelling, severe abdominal pain, and protein in the urine. It is life-threatening and must be referred immediately.
  • e.Postpartum depression is more serious than postpartum blues. The ‘blues’ are a mild sense of sadness, anxiety or confusion that many women experience after giving birth and which normally passes. Women with postpartum depression (persistent sadness and low mood with little motivation) should be referred.

SAQ 3.2 (tests Learning Outcome 3.3)

Complete the empty boxes in Table 3.1, referring to complications in the puerperium.

Table 3.1  Common complications in the puerperium.

Symptom Sign Possible diagnosis Action
Vaginal bleeding on postpartum day sevenUterus at the level mid-way between umbilicus and pelvis
Urinary traction infection (UTI)Encourage fluid intake by mouth and refer
Pain over the breast and fever Breast painful to touch, hot and red
Pain in the perineumTorn perineum with yellowish discharge, painful to touch

Answer

The completed Table 3.1 will look as follows:

Table 3.1  Common complications in the puerperium.

Symptom Sign Possible diagnosis Action
Vaginal bleeding on postpartum day sevenUterus at the level mid-way between umbilicus and pelvis Endometritis Start an IV infusion and refer
Urinary frequency and urgency Pain in the pelvis overlying the bladder Urinary tract infection (UTI) Encourage fluid intake by mouth and refer
Pain over the breast and fever Breast painful to touch, hot and red Mastitis, possibly breast abscess Give a pain killer and refer
Pain in the perineumTorn perineum with yellowish discharge, painful to touch Infected wound Salt bath, warm compresses, paracetamol for pain relief and possibly refer for antibiotics

SAQ 3.3 (tests Learning Outcome 3.4)

You are visiting a mother called Lakesh who had her baby seven days ago. The last time you saw her she was lying in bed. This time she gets up to greet you and you notice that she is limping. You ask her if she has hurt herself. She mentions a sudden ache in one of her legs. What would you suspect and what would you do about it?

Answer

You should immediately remember that the risk of deep vein thrombosis (DVT) is higher if the postnatal woman spends most of her time in bed, as Lakesh has been doing. You would quickly check if any or all of the clinical features of DVT as set out in Box 3.2 also applied. If the signs lead you to suspect that Lakesh has a DVT, you would refer her to a higher-level health facility as quickly as possible.

SAQ 3.4 (tests Learning Outcome 3.5)

Another mother called Almaz is in the first postpartum week; she feels persistently guilty and negative towards herself, cries easily and feels tired and agitated. What might she be suffering from? What other symptoms would you ask her about, to confirm your diagnosis?

Answer

The likely diagnosis for Almaz’s condition is postpartum depression. To check your diagnosis, you would ask her about the following symptoms:

  • Decreased interest or pleasure
  • Disturbed sleep, sleeping too much or sleeping too little
  • Diminished ability to think or concentrate
  • Marked loss of appetite.

Summary of Study Session 3