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Postpartum Haemorrhage

By AdminPosted On 07-Nov-2016

1. Postpartum Haemorrhage Treatment


In the management of post partum haemorrhage all of the following can be used EXCEPT


a) Ergometrine

b) Carboprost

c) Misoprostol

d) Mifepristone

e) Oxytocin


Correct Answer: d) Mifepristone. Mifepristone (or RU-486) is a synthetic steroid compound with both antiprogesterone and antiglucocorticoid properties. Mifepristone is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive.


2. Internal Iliac Artery Ligation


Which of the following statements about Internal Iliac Artery Ligation (IIAL) TRUE?


a) It decreases pulse pressure by 75%-85%

b) High ligation prevents collateral blood flow to the pelvis

c) Bilateral ligation is required to be effective

d) Pregnancy is contraindicated after bilateral ligation


Correct Answer: A. Unilateral ligation reduces pulse pressure by 77% and bilateral ligation reduces pulse pressure by 85% distal to ligation. High ligation means proximal to the posterior division. When it is ligated proximal flow can still occur distal to the point of ligation by reversed flow through the iliolumbar and lateral sacral collateral arteries.


3. Postpartum Haemorrhage


You answer an emergency call for a postpartum haemorrhage. Estimate blood loss by nurse is approximately 1 l of blood. What should you be your first action?


a) Assess the patient’s airway, breathing and circulation and administer oxygen at a rate of 15 l/min

b) Bimanual compression of the uterus

c) Catheterise the bladder

d) Obtain blood for cross match of 4 units

e) Site two large bore intravenous cannulae


Correct Answer: a) Assess the patient’s airway, breathing and circulation and administer oxygen at a rate of 15 l/min. In an acute emergency, one should always assess the airway, breathing and circulation before addressing the secondary treatment. In practice, this may be talking to the patient and to see if they respond.


4. Risks for Postpartum Haemorrhage


All of the following circumstances should alert an obstetrician to an increased likelihood of postpartum hemorrhage EXCEPT:


a) Prolonged labor

b) Rapid labor

c) Postdate pregnancy

d) Oxytocin stimulation

e) Twin pregnancy

Correct Answer: c) Postdate pregnancy.


5. Cause of Postpartum Haemorrhage


A 29 year old woman, gravida 3, para 2, presents in a active phase of labor at 39 weeks of gestation at 4 cm cervical dilatation. The duration of active phase is 2 hours; the second stage lasts for 60 minutes. The patient undergoes a spontaneous vaginal delivery of 4.05kg infant complicated by postpartum hemorrhage. The most likely cause of PPH is


a) Duration of second stage of labor

b) Length of active phase of labor

c) Maternal age

d) Infant birthweight

Correct Answer: d) Infant birthweight.

Uterine causes account for 90% of postpartum haemorrhage and are more severe than nonuterine causes. Uterine causes include uterine atony, abnormal placentation, retained placental products, inversion, or rupture. The potential for PPH exists whenever there is over distension of the uterus, as occurs with multiple gestation, hydramnios or macrosomic fetus. In the present case active phase and second stage of labor are within normal limits and also maternal age is not beyond 35 years which is independent risk factor for PPH.

(Ref- Telinde’s Operative Gynecology).

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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