A. Do nothing
B. FFP 12-15 ml/mg
C. Platelet transfusion
E. Packed red cell
F. O negative kell negative blood
G. Protamine sulphate
H. Fibrinogen concentrate
I. Recombinant factor VIIA
Each of the above options describes women presenting with postpartum haemorrhage.
For each patient select the single most appropriate management option from the list.
10. Mrs. Anna, 34 year old multiparous, delivered normally, had a major atonic postpartum haemorrhage of 1200 ml. Bleeding stopped with Bakri balloon tamponade, now bleeding settled and she is hemodynamically stable, 4th unit blood ongoing. Her Hb is 75g/L. Platelet count is 52 x10 9/L. Prothrombin time is more than 1.5times Normal. Fibrinogen is 1.8g dl.
11. Mrs.Swati Patel, delivered by forceps delivery had traumatic Postpartum haemorrhage . Recognised late as had posterior fornix tear, quantified blood loss is 1500ml. No uterine atony, bleeding still present. She is tachycardic and hypotensive.
Started with packed red blood cells
Prothrombin time is 35seconds
APTT 50 seconds
What is next best blood product to be given?
12. A woman has a massive PPH and receives a transfusion of 18 units of red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate.
Her results are as follows
Blood markers are
platelet count 60
APPT -45 seconds
PT -20 seconds
At the time of hysterectomy, consultant decided to give this blood product
A. Oxytocin 5units Iv
B. Oxytocin 10unitSIM
E. Carborpost - 4th dose to be given
G. Consider shifting to OT
I. Stepwise devascularisation
K. Tranexmic acid 1gm IV
Each of the above options describes various management of woman with postpartum haemorrhage. For each patient select the single most appropriate management from the list above. Each option may be used once, more than once or not at all
13. 34 year old Rebecca, into her second pregnancy, a low risk pregnancy. Which is best drug to prevent atonic PPH
14. 34 year old Rachel in her third pregnancy, low risk pregnancy. She is fully dilated and pushing, she has a history of atonic PPH in her previous delivery, what is the appropriate prophylactic drug for her?
K. 1in 200
Each of the following Options describes various Percentages on woman presenting with postpartum haemorrhage
For each patient, select the single most appropriate diagnosis from the list above. Each option may be used once, more than once or not at all.
15. A 26 year old Tesisly has delivered 6weeks back. She underwent caesarean section for prolonged rupture of membranes with suspected chorioamnionitis,
Now she has presented with heavy vaginal bleeding.
Her ultrasound shows retained membranes -she has consented for the evacuation of the uterus.
What is her chances of having uterine perforation?
16. A Sherlye, 32-year-old, primiparous and normal vaginal delivery. With the removal of placenta, she has increased vaginal bleeding
Her quantified blood loss is 1700ml.
She was managed with balloon tamponade
What percentage of woman, hysterectomy is avoided with tamponade
17. hat percentage of the woman with massive PPH needs to be notified to the risk management team?
E. Tissue trauma
H. Direct extension
L. Teenage pregnancy
M. Poor nutrition
N. Maternal exhaustion
O. Pulmonary embolism
Above Options show various complications of postpartum period .
Below is a scenario of young postpartum girl. Choose the appropriate option for the explanation below .
Ms, saly ,is teenage girl , An 18-year-old patient finally delivered a 4,000-g Baby Vaginally by Mid cavity rotational forceps .Her antenatal. Care was complicated by anemia, poor weight gain, and maternal obesity.
Her labor was protracted, including a 3-hour second stage, a with a tear extending upto forncieal tear and a third-degree tear whcih was sutured under anaesthesia.
22. She is more prone to develop puerperal infection. Which of the following is the greatest predisposing risk factor to develop puerperal infection in this patient?
23. She develops a persistent fever of 102°F on the fourth day postpartum. What is the most likely etiology?
24. If this infection spreads to include the supporting connective tissues of the uterus, what is it called?
25. Puerperal infection may be spread by several routes.
Which of the following is the most common route that results in serious complication of a septic thrombophlebitis?