Postpartum Care Practice Questions

Q: Most common cause of postpartum haemorrhage (PPH) is

Atonic uterus. ***Atonic uterus*** - An **atonic uterus** fails to contract adequately after birth, leading to **poor compression of blood vessels** at the placental site, which is the most common cause of **Postpartum Haemorrhage (PPH)**. - Risk factors include **uterine overdistension** (e.g., multifetal pregnancy, polyhydramnios), prolonged labor, rapid labor, and grand multiparity. *Cervical tears* - **Cervical tears** can cause significant bleeding, but they are less common than uterine atony as a primary cause of PPH. - Typically, bleeding from cervical tears is continuous and often **bright red**, sometimes occurring even with a well-contracted uterus. *Episiotomy wound* - An **episiotomy wound** can bleed, but the amount is usually limited and rarely causes severe PPH unless it's poorly repaired or extends. - It is a controlled incision and generally less likely to lead to massive hemorrhage compared to uterine atony. *Vaginal tears* - **Vaginal tears** (lacerations) can contribute to postpartum bleeding, especially if deep or extensive. - While they require repair, **vaginal tears** are generally not the most common or significant cause of severe PPH compared to an atonic uterus.

Q: Kegel's exercises should begin after?

Immediately after delivery. ***Immediately after delivery*** - **Kegel's exercises** can be initiated as soon as possible after delivery, provided the woman feels comfortable and there are no contraindications. - Early commencement helps **restore pelvic floor muscle tone**, reduce urinary incontinence, and promote healing. *24 hours after delivery* - While it is not strictly incorrect to start at 24 hours, waiting unnecessarily delays the potential benefits of **pelvic floor muscle training** for postpartum recovery. - The goal is to start as early as comfort allows, which can often be within the first few hours. *3 weeks after delivery* - Waiting three weeks to begin **Kegel's exercises** would be a significant delay in postpartum recovery. - Early engagement is crucial for **optimal rehabilitation** of the pelvic floor and prevention of long-term issues. *6 weeks after delivery* - Six weeks after delivery is typically the time for the **postpartum check-up**, but it is too late to *begin* Kegel's exercises for optimal benefit. - By this point, opportunities for **early muscle re-education** and symptom prevention would have been missed.

Q: In a multipara, the most common cause of postpartum hemorrhage is?

Uterine atonicity. ***Uterine atonicity*** - This is the **most common cause** of postpartum hemorrhage, especially in multiparous women, where the uterus may have lost some of its tone from previous pregnancies. - After delivery, the uterus normally contracts to compress blood vessels and prevent excessive bleeding; **uterine atony** prevents this essential contraction. *Retained placenta* - While a significant cause of postpartum hemorrhage, it is less common than uterine atony overall and often presents with a **non-contracted uterus** despite attempts at fundal massage. - The placenta or fragments of it remain in the uterus, preventing complete uterine contraction and leading to continuous bleeding. *Uterine perforation* - This is a rare and usually iatrogenic cause of postpartum hemorrhage, often associated with operative procedures during delivery or uterine instrumentation. - It involves a tear in the uterine wall, leading to bleeding into the abdominal cavity, which is distinct from the typical presentation of postpartum hemorrhage. *Fibroid in the uterus* - Uterine fibroids can contribute to postpartum hemorrhage by interfering with the uterus's ability to contract effectively after delivery. - However, they are **not the most common cause**; their presence increases the risk, but uterine atony remains the predominant reason for excessive bleeding.

Q: A woman complains of severe pain in the vagina after vaginal delivery. On examination, she is pale, her pulse rate is 110 beats per minute, and her blood pressure is 100/60 mm of Hg. Vaginal examination reveals a large, soft, boggy mass on the right lateral vaginal wall. What is the most appropriate treatment?

Drain and insert a figure of 8 suture. ***Drain and insert a figure of 8 suture*** - The symptoms of severe pain, pale appearance, tachycardia, hypotension, and a large, soft, boggy mass on the vaginal wall are indicative of a **vaginal hematoma**, which requires immediate surgical intervention. - The most appropriate treatment for a growing vaginal hematoma is **surgical incision, evacuation of the clot, identification and ligation of the bleeding vessel**, and closure with a figure-of-eight or continuous locking suture to achieve hemostasis. - This comprehensive approach addresses both the accumulated blood and the source of bleeding. *Analgesics and monitoring* - While pain relief is necessary, merely administering analgesics and monitoring would not address the underlying **active bleeding** and growing hematoma, which can lead to significant blood loss and hypovolemic shock. - This approach would be insufficient for a patient presenting with signs of **hemodynamic instability** (tachycardia, hypotension, pallor). *Vaginal packing* - Vaginal packing might temporarily tamponade minor bleeding in small, stable hematomas (<3-5 cm) without signs of expansion. - However, it is generally **ineffective for a rapidly expanding hematoma** from an actively bleeding vessel in a hemodynamically compromised patient. - Packing can also obscure ongoing bleeding and contribute to infection or tissue necrosis. *Conservative management with ice packs* - Conservative management with ice packs may be appropriate only for **small, non-expanding hematomas** (<3 cm) in hemodynamically stable patients. - In this case, the patient has a **large hematoma** with signs of ongoing bleeding and hemodynamic compromise (tachycardia, hypotension, pallor), making conservative management inappropriate and potentially dangerous. - Delaying surgical intervention could lead to severe hemorrhage, hypovolemic shock, and increased maternal morbidity.

Q: Which of the following is NOT a cause of postpartum hemorrhage in a well-contracted uterus?

Atony of uterus. ***Atony of uterus*** - **Uterine atony** is the **most common cause of postpartum hemorrhage** overall, accounting for 70-80% of cases - Atony **by definition** means a **poorly contracted, soft, boggy uterus** - If the uterus is **well-contracted and firm**, atony is **completely ruled out** as the cause of bleeding - The presence of a well-contracted uterus on palpation definitively excludes atony *Vaginal tear* - **Vaginal tears** can cause significant PPH even with a **well-contracted uterus** - Represents **genital tract trauma** independent of uterine tone - Bleeding is typically **bright red**, continuous, and occurs despite a **firm uterus** on examination - Part of the "Trauma" category in the 4 T's of PPH (Tone, Trauma, Tissue, Thrombin) *Cervical laceration* - **Cervical lacerations** lead to considerable blood loss **independently of uterine contraction status** - Damage to **cervical blood vessels** causes persistent bleeding - Clinical clue: **Bright red bleeding** with a **firm, well-contracted uterus** on palpation - Also part of the "Trauma" category; requires direct visualization and repair *Retained placenta* - **Retained placental tissue** typically **prevents adequate uterine contraction**, leading to a soft, poorly contracted uterus - While small fragments might coexist with a seemingly firm uterus on external palpation, **significant retained tissue** would prevent complete myometrial contraction - In the context of a **truly well-contracted uterus**, retained placenta is an unlikely primary cause of PPH - However, it remains a possible cause if only examining the fundus while fragments remain in the lower segment

Question 1

A 25-year-old patient who underwent a normal vaginal delivery complains of severe headache and visual changes postpartum. What is the most likely cause?

Accepted Answer

Postpartum preeclampsia

Answer

Transient ischemic attack (TIA)

Answer

Sheehan syndrome

Answer

Amniotic fluid embolism

Question 2

Most common cause of postpartum haemorrhage (PPH) is

Accepted Answer

Atonic uterus

Answer

Cervical tears

Answer

Episiotomy wound

Answer

Vaginal tears

Question 3

Kegel's exercises should begin after?

Accepted Answer

Immediately after delivery

Answer

24 hours after delivery

Answer

3 weeks after delivery

Answer

6 weeks after delivery

Question 4

In a multipara, the most common cause of postpartum hemorrhage is?

Accepted Answer

Uterine atonicity

Answer

Retained placenta

Answer

Uterine perforation

Answer

Fibroid in the uterus

Question 5

A woman complains of severe pain in the vagina after vaginal delivery. On examination, she is pale, her pulse rate is 110 beats per minute, and her blood pressure is 100/60 mm of Hg. Vaginal examination reveals a large, soft, boggy mass on the right lateral vaginal wall. What is the most appropriate treatment?

Accepted Answer

Drain and insert a figure of 8 suture

Answer

Analgesics and monitoring

Answer

Vaginal packing

Answer

Conservative management with ice packs

Question 6

Which of the following is NOT a cause of postpartum hemorrhage in a well-contracted uterus?

Accepted Answer

Atony of uterus

Answer

Vaginal tear

Answer

Cervical laceration

Answer

Retained placenta

Postpartum Care — MCQs

Postpartum Care — MCQs

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