POSTPARTUM HEMORRHAGE EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026

POSTPARTUM HEMORRHAGE EXAM QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026 most common cause of postpartum hemorrhage - Answers uterine atony Where does detachment of the placenta normally occur first from the uterine wall? - Answers starts at center and works its way toward the periphery How is the uterine bleeding stopped after the placenta detaches - Answers "criss-crossing" muscle cells encircling the maternal spiral arteries contract post-partum hemorrhage - Answers delivery-associated blood loss in excess of *500mL* for a vaginal delivery and in excess of *1,000 mL* for a c/s primary (early) PPH - Answers within 25 hours of delivery secondary (late) PPH - Answers occurs 24 hours but within 12 weeks after delivery ("saturating a pad within an hour") Is early or late post-partum hemorrhage more worrisome? - Answers early prevalence of post-partum hemorrhage - Answers 4% At what percent of blood loss in PPH, will a woman start developing signs? - Answers 20% clinical signs of 10-15%, 20%, 30%, and 40-50% blood loss with PPH - Answers 10-15%: no signs 20%: tachycardia, delayed capillary refill, orthostatic changes, narrowed pulse pressure 30%: breathing and HR further increases, overt hypotension develops 40-50%: oliguria, shock, coma...death 4 T's that can cause early postpartum hemorrhage - Answers 1. tone 2. trauma 3. tissue 4. thrombin (failure of blood to clot normally) most common cause of early post-partum hemorrhage - Answers tone (atony) What does the uterus feel like with atony? - Answers soft and boggy trauma that can cause early PPH (3) - Answers 1. genital tract lacerations 2. uterine inversion 3. uterine rupture tissue cause of early PPH - Answers retained placenta How can a retained placenta cause PPH - Answers if only part of the placenta detaches, the part that's left can prevent the uterus from contracting completely -- uterus that doesn't contract well can cause hemorrhage What increases the risk of atony? (6) - Answers 1. prolonged labor 2. labor augmented by oxytocin 3. rapid labor 4. over-distended uterus 5. MgSO4 treatment 6. chorioamnionitis (1 and 2 wear the uterus out) What causes trauma to the uterus causing early PPH? (4) - Answers 1. mediolateral episiotomy 2. forceps/vacuum delivery 3. macrosomnia 4. nonvertex presentation risk factors for failure of the placenta to separate from the uterus (6) - Answers 1. leiomyomata 2. previous C/S 3. prior currettage 4. prior uterine surgery 5. succenturiate lobe of the placenta 6. placental abnormalities What percent of women who have had PPH will have it in a subsequent pregnancy? - Answers 15% What are some risk factors for blood to not clot normally causing PPH? (4) - Answers 1. clotting deficiency 2. previous PPH 3. Asian/Hispanic 4. pre-eclampsia pre-eclampsia - Answers HTN and organ failure during pregnancy How can early PPH be prevented before delivery? (4) - Answers 1. baseline hct 2. blood type and screen 3. identify risk factors: PT/PTT and platelet count 4. IV access while in labor How can early PPH be prevented during labor? (7) - Answers 1. use forceps and vacuum judiciously (avoid intraoperative vaginal delivery) 2. avoid excessive traction on umbilical cord 3. inspect placenta for complete removal 4. give oxytocin to contract uterus just after delivery (decreases risk by 50%) 5. visualize cervix and vagina after deilvery 6. digitally explore the uterus if indicated 7. perform uterine massage to stimulate contraction of the uterus How can early PPH be prevented after delivery? (4) - Answers 1. closely observe for excessive bleeding 2. continue oxytocin via IV if bleeding 3. frequently palpate uterus 4. frequently determine vital signs