CMS Clinical Assessment Methods 5 — Questions and Answers
Question 1: Twelve hours after birth, where is the uterine fundus typically palpated?
- At the symphysis pubis
- About 1 cm above or at the level of the umbilicus (Correct answer)
- Midway between the umbilicus and the xiphoid
- Not palpable abdominally
Correct answer: About 1 cm above or at the level of the umbilicus
The fundus rises to about the umbilicus within 12 hours postpartum and then descends about 1 cm per day.
Question 2: A postpartum person's fundus is boggy and displaced to the right of midline. What is the most likely cause?
- Retained placental fragments
- Distended bladder (Correct answer)
- Uterine inversion
- Normal involution
Correct answer: Distended bladder
A full bladder pushes the uterus upward and to the side, which interferes with contraction and increases bleeding.
Question 3: Which method is most accurate for assessing postpartum blood loss?
- Visual estimation by the provider
- Quantitative blood loss by weighing and measuring (Correct answer)
- Change in maternal pulse alone
- Counting saturated pads without weighing
Correct answer: Quantitative blood loss by weighing and measuring
Quantitative blood loss (1 g ≈ 1 mL) is more accurate than visual estimation, which often underestimates hemorrhage.
Question 4: Lochia that is pinkish-brown and appears around days 4-10 postpartum is called what?
- Lochia rubra
- Lochia serosa (Correct answer)
- Lochia alba
- Lochia purulenta
Correct answer: Lochia serosa
Lochia serosa follows rubra and is pinkish-brown, serous, and contains leukocytes and wound exudate.
Question 5: Which acronym guides a systematic postpartum perineal assessment?
- REEDA (Correct answer)
- SOAP
- SBAR
- HELLP
Correct answer: REEDA
REEDA stands for Redness, Edema, Ecchymosis, Discharge, and Approximation of perineal wound edges.
Question 6: Which screening tool is validated for postpartum depression and has 10 self-report items?
- PHQ-2
- Edinburgh Postnatal Depression Scale (Correct answer)
- GAD-7
- Beck Anxiety Inventory
Correct answer: Edinburgh Postnatal Depression Scale
The EPDS is a 10-item validated postpartum depression screen, and item 10 assesses self-harm thoughts.
Question 7: When should Group B Streptococcus screening by rectovaginal culture be performed according to current ACOG guidance?
- 28-30 weeks
- 32-34 weeks
- 36 0/7 to 37 6/7 weeks (Correct answer)
- At the onset of labor only
Correct answer: 36 0/7 to 37 6/7 weeks
ACOG (2020) recommends universal GBS culture at 36 0/7 to 37 6/7 weeks so results stay valid for 5 weeks through most term births.
