NBME 10. 123Q. postpartum bleeding 12-18 (1)

Question 1

Postpartum bleeding or hemorrhage is commonly caused by? 3 common causes were mentioned

Answer 1

uterine atony, genital tract laceration, or retained products of conception.

Question 2

Postpartum bleeding or hemorrhage less common causes? 4

Answer 2

bleeding diathesis, placenta previa, abruptio placentae, and uterine inversion.

Question 3

Hemorrhage is classically defined as blood loss greater than? vaginal delivery and Csec?

Answer 3

500 mL after vaginal birth
1000 mL after cesarean delivery

Question 4

postpartum bleeding symptoms?

Answer 4

hemorrhagic shock, such as light headedness, diaphoresis, tachycardia, and hypotension

Question 5

MCC in general?

Answer 5

uterine atony

Question 6

uterine atony cause?

Answer 6

caused by a failure of the myometrium to contract and compress the placental blood vessels.

Question 7

uterine atony is more likely to occur in what conditions?

Answer 7

macrosomia, multiple gestations, prolonged labor, and uterine infection, and it is diagnosed with a soft uterus on abdominal examination.

Question 8

Genital tract lacerations. what causes?

Answer 8

can happen spontaneously during the childbirth process
OR
be caused by obstetric intervention, such as manual manipulation of the fetus or operative vaginal delivery.

Question 9

retained placenta can cause significant postpartum bleeding as a result of the …….?

Answer 9

inability of the placental bed to involute.

Question 10

initial Mx of postpartum bleeding?

Answer 10

fluid and blood product resuscitation, uterine massage, administration of uterotonic medications, examination of the vagina and cervix (or abdominal incision if cesarean delivery was performed), and manual extraction of retained products of conception if present on ultrasonography.

Question 11

more invasive Mx of uncontrolled postpartum bleeding?

Answer 11

More invasive management for uncontrolled hemorrhage includes dilatation and curettage, uterine vessel embolization, and hysterectomy

Question 12

myometrial atony - what uterus?

Answer 12

diagnosed with a soft uterus on abdominal examination

IF firm uterus on abdominal examination, making this cause less likely.

Question 13

Uterine inversion. risk factors? 5

Answer 13

Risk factors include uterine atony, macrosomia, preeclampsia, nulliparity, and placenta accreta.

Question 14

Uterine inversion. definition?

Answer 14

Uterine inversion occurs when the uterine fundus inverts into the endometrial or vaginal canal, often caused by excessive traction on the cord when applying fundal pressure during delivery of the placenta

Question 15

Uterine rupture can occur intrapartum or postpartum. CP?

Answer 15

presents with fetal distress and loss of station (if intrapartum), abdominal pain, uterine tenderness, vaginal bleeding, and abnormal uterine shape on examination

Question 16

Uterine rupture can be accompanied by…?

Answer 16

It can be accompanied by hemodynamic instability and requires operative repair. This patient has a firm uterine fundus, making rupture unlikely.

Question 17

Normal lochia what is it? how long last up?

Answer 17

Vaginal discharge that is often bloody initially following delivery and may last up to 4 to 6 weeks.

Question 18

Normal lochia - is it cause bleeding?

Answer 18

Lochia is not associated with significant blood loss