Treatment of Postpartum Hemorrhage Multiple Choice Questions with Answers
A 30-year-old woman gave birth to a healthy baby boy via vaginal delivery. Approximately 30 minutes after delivery, she suddenly begins to bleed heavily. Which of the following is the most appropriate initial step in the management of this patient?
A. Administering oxytocin
B. Performing a bimanual uterine massage
C. Initiating a massive transfusion protocol
D. Preparing for emergent hysterectomy
Answer: B. Performing a bimanual uterine massage
Explanation: The most common cause of postpartum hemorrhage is uterine atony. In this scenario, the appropriate initial step is to perform a bimanual uterine massage to stimulate the uterus and control bleeding. Oxytocin administration is also appropriate, but it is not the initial step. Massive transfusion protocol and emergent hysterectomy may be necessary in severe cases, but they are not the initial steps.
A 25-year-old woman gave birth to a healthy baby girl via vaginal delivery. Shortly after delivery, she begins to bleed heavily and her blood pressure drops. The obstetrician suspects uterine atony as the cause of bleeding. Which of the following medications should be administered first?
A. Misoprostol
B. Carboprost
C. Oxytocin
D. Methylergonovine
Answer: C. Oxytocin
Explanation: Oxytocin is the first-line medication for postpartum hemorrhage due to uterine atony. It stimulates uterine contractions and helps to control bleeding. Misoprostol can also be used as an alternative to oxytocin. Carboprost and methylergonovine are second-line medications used if oxytocin and misoprostol are ineffective.
A 35-year-old woman gave birth to a healthy baby boy via cesarean section. During surgery, the obstetrician notes that the patient has a placenta accreta. Shortly after delivery, the patient begins to bleed heavily. Which of the following is the most appropriate next step in the management of this patient?
A. Performing a bimanual uterine massage
B. Administering tranexamic acid
C. Preparing for emergent hysterectomy
D. Attempting manual removal of the placenta
Answer: C. Preparing for emergent hysterectomy
Explanation: Placenta accreta is a serious complication of pregnancy that can lead to postpartum hemorrhage. In this scenario, the most appropriate next step is to prepare for emergent hysterectomy to remove the uterus and control bleeding. Performing a bimanual uterine massage and attempting manual removal of the placenta are not appropriate in this scenario. Tranexamic acid may be used to help control bleeding, but it is not the most appropriate next step.
A 28-year-old woman gave birth to a healthy baby boy via vaginal delivery. Shortly after delivery, the patient begins to bleed heavily and her blood pressure drops. The obstetrician suspects a cervical laceration as the cause of bleeding. Which of the following is the most appropriate initial step in the management of this patient?
A. Performing a bimanual uterine massage
B. Administering tranexamic acid
C. Repairing the cervical laceration
D. Initiating a massive transfusion protocol
Answer: C. Repairing the cervical laceration
Explanation: Cervical lacerations can occur during vaginal delivery and can cause postpartum hemorrhage. In this scenario, the most appropriate initial step is to repair the cervical laceration to stop the bleeding. Performing a bimanual uterine massage may also be helpful.
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