Postpartum Hemorrhage UPDATED Exam
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Postpartum hemorrhage - CORRECT ANSWER is excessive maternal bleeding after
delivery of an infant and has multiple causes. Postpartum hemorrhage is classified into two
groups: early postpartum hemorrhage and late postpartum hemorrhage. The most common
cause of early postpartum hemorrhage is uterine atony, but it can also be caused by trauma,
lacerations, and hematomas. Late postpartum hemorrhage is most commonly caused by
retained placental fragments.
Timing of early postpartum hemorrhage - CORRECT ANSWER Occurs in the first 24
hours after childbirth
Timing of late postpartum hemorrhage - CORRECT ANSWER Occurs after 24 hours
for up to 12 weeks after childbirth
causes of early postpartum hemorrhage - CORRECT ANSWER Uterine atony
Trauma to the birth canal during labor and birth caused by lacerations, episiotomies, or
uterine rupture
Hematomas (localized collections of blood in a space or tissue)
Retention of placental or amniotic fragments
Abnormalities of coagulation
Causes of late postpartum hemorrhage - CORRECT ANSWER Subinvolution (delayed
return of the uterus to its nonpregnant size and consistency)
Retained placental or amniotic fragments
Infection of the uterus
Uterine Atony - CORRECT ANSWER This is the most common cause of early
postpartum hemorrhage. Relaxed uterine muscles allow rapid bleeding from endometrial
arteries.
, This is characterized by a fundus that feels "boggy" (soft, flaccid) or is difficult to locate.
Risk Factors for uterine atony - CORRECT ANSWER Contractions that were
minimally effective, resulting in prolonged labor
Contractions that were excessively vigorous, resulting in precipitate labor
Placental abruption: early detachment of the placenta from the uterus
Placenta previa: the placenta covers or is near the cervical opening
Overdistended uterus: excessive enlargement of the uterus due to too much amniotic fluid
(polyhydramnios) or a large infant (macrosomia), especially with birthweight of more than
4000 grams (8.8 pounds)
Multifetal gestation
Pregnancy-induced hypertension (PIH)
Multiparity
Prolonged labor
Maternal infection
Endometriosis
Maternal obesity
Induction or augmentation of labor with oxytocin
Tocolytic medications to stop contractions (for preterm labor)
General anesthesia
Vacuum extractor—or forceps-assisted delivery
History of postpartum hemorrhage
Best practice dictates that all women be screened throughout their hospital stay for their risk
for postpartum hemorrhage. This risk may increase due to - CORRECT
ANSWER events in labor and delivery. When a high hemorrhage risk is identified, the
interdisciplinary team should work together with the blood bank to ensure there is an
adequate blood supply on-hand. A Type & Cross and CBC should be obtained.
Soft tissue trauma (lacerations, hematomas) can cause - CORRECT ANSWER rapid
loss of blood even when the uterus is firmly contracted.
ACTUAL QUESTIONS AND CORRECT
ANSWERS
Postpartum hemorrhage - CORRECT ANSWER is excessive maternal bleeding after
delivery of an infant and has multiple causes. Postpartum hemorrhage is classified into two
groups: early postpartum hemorrhage and late postpartum hemorrhage. The most common
cause of early postpartum hemorrhage is uterine atony, but it can also be caused by trauma,
lacerations, and hematomas. Late postpartum hemorrhage is most commonly caused by
retained placental fragments.
Timing of early postpartum hemorrhage - CORRECT ANSWER Occurs in the first 24
hours after childbirth
Timing of late postpartum hemorrhage - CORRECT ANSWER Occurs after 24 hours
for up to 12 weeks after childbirth
causes of early postpartum hemorrhage - CORRECT ANSWER Uterine atony
Trauma to the birth canal during labor and birth caused by lacerations, episiotomies, or
uterine rupture
Hematomas (localized collections of blood in a space or tissue)
Retention of placental or amniotic fragments
Abnormalities of coagulation
Causes of late postpartum hemorrhage - CORRECT ANSWER Subinvolution (delayed
return of the uterus to its nonpregnant size and consistency)
Retained placental or amniotic fragments
Infection of the uterus
Uterine Atony - CORRECT ANSWER This is the most common cause of early
postpartum hemorrhage. Relaxed uterine muscles allow rapid bleeding from endometrial
arteries.
, This is characterized by a fundus that feels "boggy" (soft, flaccid) or is difficult to locate.
Risk Factors for uterine atony - CORRECT ANSWER Contractions that were
minimally effective, resulting in prolonged labor
Contractions that were excessively vigorous, resulting in precipitate labor
Placental abruption: early detachment of the placenta from the uterus
Placenta previa: the placenta covers or is near the cervical opening
Overdistended uterus: excessive enlargement of the uterus due to too much amniotic fluid
(polyhydramnios) or a large infant (macrosomia), especially with birthweight of more than
4000 grams (8.8 pounds)
Multifetal gestation
Pregnancy-induced hypertension (PIH)
Multiparity
Prolonged labor
Maternal infection
Endometriosis
Maternal obesity
Induction or augmentation of labor with oxytocin
Tocolytic medications to stop contractions (for preterm labor)
General anesthesia
Vacuum extractor—or forceps-assisted delivery
History of postpartum hemorrhage
Best practice dictates that all women be screened throughout their hospital stay for their risk
for postpartum hemorrhage. This risk may increase due to - CORRECT
ANSWER events in labor and delivery. When a high hemorrhage risk is identified, the
interdisciplinary team should work together with the blood bank to ensure there is an
adequate blood supply on-hand. A Type & Cross and CBC should be obtained.
Soft tissue trauma (lacerations, hematomas) can cause - CORRECT ANSWER rapid
loss of blood even when the uterus is firmly contracted.
