Massive obstetric haemorrhage is variably defined as: blood loss >1500 ml; a decrease in haemoglobin >4 g dl−1; or acute transfusion requirement >4 units.3 Obstetric haemorrhage is classified as antepartum (APH); bleeding occurring after 24 weeks gestation and before delivery, or postpartum (PPH). Since this is a review, answers and rationales are shown after you click on the "Check" button. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Hysterectomy is rare but should be considered in life-threatening haemorrhage where other measures have failed. Trauma: there may be visible lacerations or tears on vaginal examination. Answers and rationales are given below. Threads  Major obstetric haemorrhage (MOH) remains a challenge for anaesthetists and obstetricians. Postpartum haemorrhage (PPH) is defined as a blood loss of 500ml or more following childbirth.1. Urea & electrolytes and liver function tests: to assess baseline function. Pharmacological: uterotonic drugs (oxytocin, syntometrine, carboprost, misoprostol). Which Harry Potter Hogwarts House Do You Belong To Quiz! Royal College of Obstetricians and Gynaecologists. Tone: an atonic (not well contracted) uterus accounts for up to 80% of cases of primary PPH. Spend your time wisely! Secondary PPH: PPH occurring from 24 hours up to 12 weeks post-delivery. It is important to understand the causes of PPH and have an approach to clinical assessment and management of this common obstetric emergency. To be considered a PPH, what would the estimated blood loss have to be for a C-section? Analysis of the project site Worldwide, obstetric haemorrhage is responsible for 27% of all maternal deaths, most of which occur in low- and middle-income countries[3]… Increased heart rate. Retained placenta. Obstetrics quiz Congratulations - you have completed ... What is the most common cause of postpartum haemorrhage? Minor PPH: 500-1000ml blood loss without clinical signs of shock. MCQ on Hemorrhage … For women who already have risk factors for PPH, active management is strongly recommended. Ensure that documentation is clear, with accurate timings of each step taken. We've also just launched an OSCE Flashcard Collection which contains over 800 cards. balloon tamponade) options. Check out our brand new quiz platform, with over 2000 MCQs at geekyquiz.com. Table 1. Surgical evacuation of retained products of conception may be necessary. Consider a pelvic ultrasound scan if retained products are suspected. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 6. Assess for signs of haemodynamic instability: heart rate, blood pressure, central capillary refill time. 4. Some women will have risk factors for heavy bleeding… All patients with PPH should have their vital signs taken as part of their clinical assessment and management.1, The following blood tests should be taken as part of the management of primary PPH:1. Trauma  As a guide, prior to blood results being available, it is reasonable to assume that fresh frozen plasma will need to be given after every 4 units of red blood cells. Guidelines. Reply. (Tissue, Tone, Trauma, Thrombon). The most common cause of secondary PPH is endometritis, which may present with the following clinical features: PPH is a clinical diagnosis based on signs and symptoms. B. Vulval or vaginal lacerations. Tone. Postpartum Hemorrhage What is postpartum hemorrhage? Estimating blood loss from PPH can be challenging. Postpartum hemorrhage is excessive bleeding following the birth of a baby. haemophilia or use of low molecular weight heparin). Weighing swabs can help with assessing the volume of blood loss. However, it is important that women are informed of the increased risk of postpartum haemorrhage if they opt for passive management. Postpartum haemorrhage is defined as blood loss of over 500ml following childbirth and is one of the leading direct causes of maternal mortality in the UK. Consider the best place for care following a PPH, which may be critical care if invasive monitoring is required. Secondary Postpartum Haemorrhage. While it is expected that some blood will be lost as part of the normal birthing process, a postpartum haemorrhage (PPH) is excessive bleeding following birth.A primary PPH is when there is loss of more than 500 mL after a vaginal birth or 1000 mL following a caesarean section, in the first 24 hours. Quantitative measurement of postpartum bleeding begins immediately after the birth of the infant and entails measuring cumulative blood loss with a calibrated underbuttocks drape, … 3- Secondary Postpartum haemorrhage: A. PPH is a preventable condition and primary interventions including active management of the 3rd stage of labor, use of uterotonics, and uterine massage. PPH can be a traumatic experience for patients and debriefing may be required. Consider administration of tranexamic acid. 59 Bleeding in the third trimester, 121 Lawrence W. Oppenheimer and the late Carl A. Nimrod 60 Normal and abnormal labor, 123 Wayne R. Cohen 61 Operative vaginal delivery, 126 Edward R. Yeomans 62 Preterm labor, 128 Erol Amon and Thomas D. Myles 63 Prelabor rupture of the membranes, 130 Joaquin Santolaya-Forgas, Roberto Romero, Postpartum hemorrhage (PPH) remains a major traumatic event that can occur after delivery. Secondary PPH is usually caused by endometritis and/or retained products of conception. 5. 1. Postpartum haemorrhage (PPH) is defined as a blood loss of 500ml or more following childbirth. Consider supplemental oxygen. Just a quick quiz to see how much your overloaded student brain was able to take in after reading so many different wiki pages ;), Instrumental assisted birth (vacuum or forceps), Lacerations of the cervix or vaginal wall, Previous PPH; polyhydramnios; multiple pregnancy; anaemia conditions, Abruptio placenta; mollydominos, grand multi; iron deficiency. A priority nursing intervention is to check blood pressure. This stage can be managed “passively” or “actively” depending on maternal preference. in the first six weeks after delivery of the placenta B. If you'd like to support us and get something great in return, check out our OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. 4.b 5.c 6.d 7.a 8.a 9.c 10.c. They cause continuous uterine contractions and may elevate blood pressure. The symptoms of postpartum hemorrhage may look like other health conditions. Read each question carefully and choose the best answer. Travel  DeepDyve is the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Over distended uterus b. Postpartum Hemorrhage Quiz 10 Questions | By Oranda | Last updated: Dec 29, 2020 | Total Attempts: 17798 Questions All questions 5 questions 6 questions 7 questions 8 questions 9 questions 10 questions … Medical Abbreviations And Calculations Quiz. Patients with PPH should be managed using an ABCDE approach with senior input from the obstetric team. Postpartum haemorrhage is an obstetric emergency which should be managed by a senior obstetrician with support from anaesthetic and midwifery teams. Topics: Postpartum Care, Lochias!. Sepsis screening involves the following additional investigations:3. 3. tachycardia, The 4 “T’s” of PPH are:  Atonic bleeding is due to a lack of tone in the uterus. Anaemia possibly requiring blood transfusion, Hypovolaemic shock leading to organ dysfunction such as acute kidney injury, Sheehan’s syndrome (postpartum pituitary gland necrosis). About 4 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. The most common cause of secondary PPH is endometritis and/or retained products of conception. Coagulation screen: heavy bleeding can lead to disordered clotting. Maternity Nursing: Postpartum NCLEX Practice Questions #8 | 55 Questions NEW! The main clinical feature of PPH is heavy bleeding from the vagina (or directly from the uterus at caesarean section). A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 1. Postpartum hemorrhage occurs when a woman loses more than 500 mL of blood in a normal delivery and more than 1000mL of blood in a cesarean delivery within 24 hours. All expectant women are considered to be at risk of PPH and its effects. Postpartum hemorrhage (PPH) is an obstetric emergency and is defined as a blood loss ≥ 1000 mL or blood loss presenting with signs or symptoms of. Md Mamunur Reza says: February 15, 2013 at 10:25 am. A. Obstetrics & Gynaecology – MCQ 65 – Risk of postpartum hemorrhage. Guidelines. C. Twin pregnancy. Tears  Postpartum hemorrhage is more bleeding than normal after the birth of a baby. Previous PPH (particularly when the cause was atony), Overdistension of the uterus (polyhydramnios/macrosomia/multiple pregnancy). Mechanical: rub the uterine fundus to stimulate contractions and/or bi-manual compression (one hand in the vagina with the other hand compressing the uterine fundus). Decrease in the red blood cell count. Postpartum hemorrhage is excessive bleeding following the birth of a baby. 1 Worldwide, haemorrhage remains a major cause of maternal death—it is estimated that between one-quarter and a half of preventable … A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. If continued bleeding occurs during the third stage with a contracted uterus, the cause is most likely to be: What are four risk factors for PPH (arising during pregnancy)? The causes of primary PPH are often referred to as the “four T’s”:1,3, Secondary PPH is usually due to one of two causes:3. Tissue: retained products of conception (e.g. It is more likely with a cesarean birth. Abortion med-ed-online 3. Hypertension. About 1 to 5 percent of women have postpartum hemorrhage and it is more likely with a cesarean birth. Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. These time frames may vary depending on factors such as the ability of students and the resources available to support the teaching–learning process and the schedule of the A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 4 Postpartum haemorrhage require a minimum of two weeks for effective teaching and learning, while each technical module will require from ten days to two weeks. Tranexamic acid, a clot stabilizing medication, may also be used to reduce bleeding and blood transfusions in low-risk women, however evidence as of 2015 was not strong. 7. Quiz: Which Anime Character Are You Most Like? In the 2009-2012 UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidities (MBRRACE) Report, the mortality rate due to obstetric haemorrhage, which also includes postpartum haemorrhage, was 4.9 per million maternities[2]. Primary PPH: PPH occurring within 24 hours of delivery. Most hospitals will have a major obstetric haemorrhage protocol which should be activated if there is >1000ml blood loss with ongoing bleeding. The NCLEX Exam: Obstetrical Nursing – Postpartum includes 55 multiple choice questions in 2 sections. Defining postpartum hemorrhage (PPH) is problematic and has been historically difficult. There may also be signs of haemodynamic instability, such as tachycardia, hypotension, prolonged capillary refill time or cool peripheries. 1. > 500  blood loss over 24 hrs  2. hypotension  Tissue: on examination of the placenta, the placental tissue or membranes may be incomplete. Electronic Fetal Heart Monitoring Trivia Quiz Questions! Estimate blood loss and assess for ongoing bleeding. Swelling and pain in the vagina and nearby area if bleeding is from a hematoma. Use of uterotonic drugs (e.g. Patient Summary Heavy bleeding after a baby is born (postpartum haemorrhage) is a complication of pregnancy that has the potential to be very serious, even resulting in death in rare cases. Assess patients with PPH for signs of haemodynamic instability and ensure adequate intravenous access. B. Macrosomia. Hypertension. Thrombin: underlying disorders of clotting (e.g. The following complications during pregnancy increase the risk of postpartum hemorrhage (PPH) except: A. Trivia Quiz. Endometritis: infection of the endometrium. Active management of the third stage of labour reduces the risk of PPH. There were three deaths due to APH: two followed placental abruption and one was from placenta praevia percreta. Group & save and crossmatch: to enable transfusion of cross-matched blood. It is testament to improved management that despite an incidence of 1 per 270 deliveries in the UK, mortality has decreased to <1 per 256 000 deliveries. Consider using point of care testing to estimate haemoglobin level (e.g. Correct answer : A. Toxins  Consultant Obstetrician and Gynaecologist, You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. It most often happens after the placenta is delivered, but it can also happen later. Signs of sepsis: tachycardia, hypotension and pyrexia. 8. An ABCDE approach should be adopted when managing patients with PPH. Hemorrhage most commonly occurs after the placenta is delivered. The purpose of the protocol is to minimise delays in accessing blood products. The physician should be notified if hypertension is present. Read and understand each question before choosing the best answer. 10 Comments Periplasm says: March 14, 2012 at 9:21 am. Airway: consider airway adjuncts and call for anaesthetic support if there is an airway problem. What types of trauma during labour and birth would lead to PPH risk? MCQ.10 A 25 years old 2comes to emergency, after homeP delivery with heavy bleeding per vaginum. Postpartum haemorrhage can be primary (within 24 h of delivery) or secondary (24 h to six weeks after delivery). The uterus may be tender or bulky on palpation. 1.a 2.c 3. Be sure to read them. If the placenta is retained and there is ongoing bleeding, it may be necessary to go to theatre for manual removal of the placenta/retained tissues. MCQ on bleeding in early pregnancy DRManal Behery Zagazig University 2013 med-ed-online 2. PPH can be categorised according to the volume of blood loss and timing of the haemorrhage: Minor PPH: 500-1000ml blood loss without clinical signs of shock. You are given one minute per question. I am from Bangladesh a fresh agriculturist. retained placenta). See the GeekyMedics article here for more information on the acute management of sepsis. Tone: the uterus may feel enlarged, soft or “boggy”. It is the number one cause of maternal morbidity and mortality worldwide. A 2017 trial found that it decreased the risk of death from bleeding from 1.9% to 1.5% in women with postpartum bleeding. D. Hydramnios. Antenatal anaemia (if microcytic or normocytic) should be treated with iron supplementation and monitored for improvement. All pregnant women should have a full blood count carried out at booking and at 28 weeks gestation. . Not recur subsequent pregnancies C. Is usually due to an underlying clotting defect D. Is always revealed 4- When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect: In which of these cases could you diagnose PPH following vaginal delivery:  About 1 in 100 to 5 in 100 women have postpartum hemorrhage. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. Placenta praevia; polyhydramnios, outeruterine death, hyroplanes, Removing question excerpt is a premium feature. Trauma: injury as a result of childbirth, most commonly perineal tears, lacerations and/or episiotomy. Is bleeding in excess of 500 ml. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. PPH can be categorised according to the volume of blood loss and timing of the haemorrhage: Postpartum haemorrhage is one of the leading direct causes of maternal mortality in the UK.2.
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