••• Chapter 11^ The Puerperium^107
❍ What are the three main causes of secondary postpartum hemorrhage?
Abnormal involution of the placenta site, retained placenta, and uterine infection.
❍ True or False: For late postpartum hemorrhage, uterine curettage is the initial treatment of choice.
False. Curettage is reserved for failed medical management.
❍ True or False: Breastfeeding is contraindicated in women with HIV infection due to the risk of transmission.
True. The frequency of breast milk transmission is estimated to be 15% to 20%; thus, breastfeeding is
contraindicated in situations where formula is available and can be reconstituted with water safe for the infant’s
consumption.
❍ True or False: Breastfeeding is contraindicated in hepatitis B.
False. Breastfeeding is not contraindicated if hepatitis B immune globulin and vaccine are given to the infants
of seropositive mothers.
❍ True or False: Breastfeeding is contraindicated in the mother with active herpes simplex virus.
False. Breastfeeding is appropriate if there are no breast lesions and the mother is meticulous about hand washing
before handling the infant and breastfeeding.
❍ True or False: Weight loss compromises a woman’s ability to supply her infant with sufficient nutrition while
breastfeeding.
False. Breastfeeding is not compromised by moderate amounts of weight loss.
❍ How many days or weeks postpartum is mastitis most commonly seen?
4 to 5 weeks.
❍ True or False: Mastitis is usually bilateral.
False.
❍ What are the clinical signs and symptoms of mastitis?
Marked breast engorgement, fever, chills, and hard reddened painful area of the affected breast.
❍ What is the approximate incidence of abscess complicating mastitis?
10%.
❍ What is the most common organism causing mastitis?
Staphylococcus aureus.
❍ True or False: A woman with mastitis should discontinue breastfeeding due to the possibility of infecting^
the infant.
False. The causal organisms typically originate from the infant’s nasopharynx, and discontinuation of breastfeeding
increases maternal risk of abscess formation.