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ACOG Postpartum Hemorrhage Questions With
Complete Solutions
True or false. If a woman has lost < 500 mL of blood
but is exhibiting signs and symptoms of shock, for clinical
purposes, she is not experiencing a "hemorrhage". -
.....ANSWER... ✔✔ False. Any volume of blood loss
that causes the client to display S&S of shock is
considered a hemorrhage.
What is severe PPH? - .....ANSWER... ✔✔ >1000mL
blood loss following a vaginal delivery
When does secondary PPH occur? - .....ANSWER...
✔✔ Between 24 hrs - 12 weeks postpartum
What is the incidence of PPH worldwide? -
.....ANSWER... ✔✔ 6%
What is the incidence of PPH in Canada? -
.....ANSWER... ✔✔ Based on 2004 estimates, 5.1%.
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What is the incidence of secondary PPH worldwide? -
.....ANSWER... ✔✔ 1 to 3%
What are the four T's? - .....ANSWER... ✔✔ Tone
(70%)
Tissue (10%)
Trauma (20%)
Thrombin (1%)
List the T's in the order of most frequent. - .....ANSWER...
✔✔ Tone,
Trauma,
Tissue,
Thrombin
What are five reasons a woman might experience
uterine atony? - .....ANSWER... ✔✔ 1. Exhaustion of
uterine muscles
2. Over-distension of the uterus
3. Chorioamnioitis
4. Anatomic distortion of the uterus
5. Uterine-relaxation agents
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What are some risk factors that might cause exhaustion
of the uterine muscles? - .....ANSWER... ✔✔
Precipitous or prolonged labour
Augmentation or induction of labour
Hx of PPH
What are some risk factors for an over-distended
uterus? - .....ANSWER... ✔✔ Polyhydramnios
Multiple gestation
Fetal macrosomia
What is a complication associated with prolonged
PROM that can increase the woman's likelihood of
experiencing a PPH? - .....ANSWER... ✔✔
Chorioamniotis, however "the most important single
predictive factor for chorioamniotis was multiple vaginal
exams"
What are some clinical findings (i.e. risk factors) that can
cause the uterus to be anatomically distorted? -
.....ANSWER... ✔✔ Fibroids
Placenta previa/low-lying placenta
Uterine anomalies
Bladder distension
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What are some risk factors that would increase one's
likelihood of experiencing genital tract trauma? -
.....ANSWER... ✔✔ Precipitous labour
Episiotomy
Operative delivery
Shoulder dystocia
Uterine inversion is type of genital tract trauma that can
cause a woman to hemorrhage. What are some risk
factors associated with uterine inversion? - .....ANSWER...
✔✔ Fundal placenta
Excessive cord traction
Grand multiparity
What are two preexisting coagulation disorders that
can predispose a woman to having a PPH? -
.....ANSWER... ✔✔ 1. Von Willebrand's disease
2. Hemophilia
What are some coagulation disorders a woman may
acquire during pregnancy? - .....ANSWER... ✔✔ 1.
Disseminated intravascular coagulation
2. Thrombocytopenia
ACOG Postpartum Hemorrhage Questions With
Complete Solutions
True or false. If a woman has lost < 500 mL of blood
but is exhibiting signs and symptoms of shock, for clinical
purposes, she is not experiencing a "hemorrhage". -
.....ANSWER... ✔✔ False. Any volume of blood loss
that causes the client to display S&S of shock is
considered a hemorrhage.
What is severe PPH? - .....ANSWER... ✔✔ >1000mL
blood loss following a vaginal delivery
When does secondary PPH occur? - .....ANSWER...
✔✔ Between 24 hrs - 12 weeks postpartum
What is the incidence of PPH worldwide? -
.....ANSWER... ✔✔ 6%
What is the incidence of PPH in Canada? -
.....ANSWER... ✔✔ Based on 2004 estimates, 5.1%.
,2|Page
What is the incidence of secondary PPH worldwide? -
.....ANSWER... ✔✔ 1 to 3%
What are the four T's? - .....ANSWER... ✔✔ Tone
(70%)
Tissue (10%)
Trauma (20%)
Thrombin (1%)
List the T's in the order of most frequent. - .....ANSWER...
✔✔ Tone,
Trauma,
Tissue,
Thrombin
What are five reasons a woman might experience
uterine atony? - .....ANSWER... ✔✔ 1. Exhaustion of
uterine muscles
2. Over-distension of the uterus
3. Chorioamnioitis
4. Anatomic distortion of the uterus
5. Uterine-relaxation agents
,3|Page
What are some risk factors that might cause exhaustion
of the uterine muscles? - .....ANSWER... ✔✔
Precipitous or prolonged labour
Augmentation or induction of labour
Hx of PPH
What are some risk factors for an over-distended
uterus? - .....ANSWER... ✔✔ Polyhydramnios
Multiple gestation
Fetal macrosomia
What is a complication associated with prolonged
PROM that can increase the woman's likelihood of
experiencing a PPH? - .....ANSWER... ✔✔
Chorioamniotis, however "the most important single
predictive factor for chorioamniotis was multiple vaginal
exams"
What are some clinical findings (i.e. risk factors) that can
cause the uterus to be anatomically distorted? -
.....ANSWER... ✔✔ Fibroids
Placenta previa/low-lying placenta
Uterine anomalies
Bladder distension
, 4|Page
What are some risk factors that would increase one's
likelihood of experiencing genital tract trauma? -
.....ANSWER... ✔✔ Precipitous labour
Episiotomy
Operative delivery
Shoulder dystocia
Uterine inversion is type of genital tract trauma that can
cause a woman to hemorrhage. What are some risk
factors associated with uterine inversion? - .....ANSWER...
✔✔ Fundal placenta
Excessive cord traction
Grand multiparity
What are two preexisting coagulation disorders that
can predispose a woman to having a PPH? -
.....ANSWER... ✔✔ 1. Von Willebrand's disease
2. Hemophilia
What are some coagulation disorders a woman may
acquire during pregnancy? - .....ANSWER... ✔✔ 1.
Disseminated intravascular coagulation
2. Thrombocytopenia
