Postpartum Complications — MCQs
A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?
After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:
Most common cause of postpartum haemorrhage (PPH) is
Which of the following is NOT a cause of postpartum hemorrhage in a well-contracted uterus?
A 24-year-old woman with bacterial vaginosis is admitted to the hospital in preterm labor at 30 weeks. What is the most appropriate antibiotic regimen?
A multigravida woman in labor room, after delivery and placenta removal, uncontrolled bleeding was seen. What is the most common cause of PPH in this woman?
A woman at 30 weeks of gestation is diagnosed with deep vein thrombosis (DVT). Which of the following is the most appropriate treatment for this patient?
Commonest cause for puerperal sepsis is :
What is the primary use of prophylactic methergin?
Postpartum Complications Indian Medical PG Practice Questions and MCQs
Question 1: A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
- A. Postpartum depression
- B. Postpartum blues (Correct Answer)
- C. Postpartum psychosis
- D. Postpartum anxiety
Explanation: ***Postpartum blues*** - This condition presents with mild, transient symptoms like **tearfulness**, **mood swings**, and **insomnia** typically peaking around **4-5 days postpartum** and resolving within two weeks. - It is a very common, self-limiting condition impacting up to 80% of new mothers, attributed to drastic **hormonal shifts** post-delivery. *Postpartum depression* - Symptoms are similar to postpartum blues but are more **severe**, last longer (typically **beyond two weeks**), and significantly impair functioning. - It often includes feelings of **hopelessness**, pervasive sadness, loss of pleasure, and sometimes thoughts of harming oneself or the baby. *Postpartum psychosis* - This is a severe psychiatric emergency characterized by **hallucinations**, delusions, disorganized thinking, and bizarre behavior, usually within the first 2-3 weeks postpartum. - It is a rare condition requiring **urgent medical intervention** due to the high risk of harm to mother and baby. *Postpartum anxiety* - While anxiety can co-occur with postpartum blues or depression, primary postpartum anxiety specifically involves excessive and **uncontrollable worry** or fear, often about the baby's health or safety. - It does not typically present with the prominent **tearfulness** and **mood swings** characteristic of blues or depression.
Question 2: What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?
- A. Venous thromboembolism
- B. Deep vein thrombosis (Correct Answer)
- C. Pulmonary embolism
- D. Leg swelling
Explanation: ***Deep vein thrombosis*** - **Pregnancy** is a **hypercoagulable state** due to increased levels of clotting factors (fibrinogen, factors VII, VIII, X) and decreased protein S activity. - **Prolonged sitting** during long journeys causes **venous stasis** in the lower extremities, which is a key component of **Virchow's triad** for thrombosis (stasis, hypercoagulability, endothelial injury). - **DVT** is the **direct and most specific pathological consequence** of prolonged immobilization during travel in pregnancy. - The risk of **VTE in pregnancy** is **4-5 times higher** than in non-pregnant women, with travel-related DVT being a recognized complication. *Venous thromboembolism* - VTE is an **umbrella term** that encompasses both **DVT and pulmonary embolism**. - While technically correct as a broader category, DVT is the **more specific and direct answer** to what prolonged sitting causes. - In medical education and clinical practice, identifying the **specific pathology** (DVT) is more appropriate than using the general category (VTE). *Pulmonary embolism* - PE is a **complication** of DVT, occurring when a thrombus dislodges and embolizes to the pulmonary circulation. - PE is a **secondary consequence**, not the **primary risk** from prolonged sitting itself. - The direct mechanism of prolonged sitting → venous stasis → **DVT formation** → potential embolization to lungs. *Leg swelling* - **Leg swelling** (edema) is a **symptom**, not a pathological diagnosis. - While leg edema can indicate DVT, it's also common in normal pregnancy due to increased venous pressure and fluid retention. - The question asks for a **risk** (pathological condition), not a symptom.
Question 3: After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:
- A. Check for laceration of labia
- B. Uterine massage and I/V oxytocin
- C. APGAR scoring (Correct Answer)
- D. Check for placenta in uterus
Explanation: ***APGAR scoring*** - **APGAR scoring** assesses the newborn's health immediately after birth and is not a management step for **postpartum hemorrhage**. - This intervention would divert critical attention from the mother's life-threatening bleeding. *Check for placenta in uterus* - **Retained placental fragments** are a common cause of **postpartum hemorrhage**, obstructing uterine contraction. - Checking for and removing any retained placenta is a crucial and immediate management step to control bleeding. *Check for laceration of labia* - **Lacerations of the birth canal**, including the labia, vagina, or cervix, can cause significant bleeding after delivery, even with a well-contracted uterus. - Identifying and repairing these lacerations is an essential part of managing **postpartum hemorrhage not due to atony**. *Uterine massage and I/V oxytocin* - **Uterine atony** (failure of the uterus to contract) is the most common cause of **postpartum hemorrhage**. - **Uterine massage** helps stimulate contraction, and **intravenous oxytocin** is a uterotonic agent used to promote uterine contraction and reduce bleeding.
Question 4: Most common cause of postpartum haemorrhage (PPH) is
- A. Atonic uterus (Correct Answer)
- B. Cervical tears
- C. Episiotomy wound
- D. Vaginal tears
Explanation: ***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.
Question 5: Which of the following is NOT a cause of postpartum hemorrhage in a well-contracted uterus?
- A. Vaginal tear
- B. Cervical laceration
- C. Atony of uterus (Correct Answer)
- D. Retained placenta
Explanation: ***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 6: A 24-year-old woman with bacterial vaginosis is admitted to the hospital in preterm labor at 30 weeks. What is the most appropriate antibiotic regimen?
- A. Metronidazole 2g orally single dose
- B. Clindamycin 300mg orally twice daily for 7 days
- C. Clindamycin 5g vaginal cream for 7 days
- D. Metronidazole 500mg orally twice daily for 7 days (Correct Answer)
Explanation: ***Metronidazole 500mg orally twice daily for 7 days*** - This regimen is an appropriate and effective treatment for **bacterial vaginosis**, with **oral metronidazole** being a first-line therapy. - Treating **bacterial vaginosis** in a pregnant woman with **preterm labor** is crucial as untreated BV is a known risk factor for preterm birth and other obstetric complications. *Metronidazole 2g orally single dose* - While a **single-dose 2g metronidazole** regimen is an alternative for non-pregnant patients, it is generally **less effective** and not typically recommended for pregnant women, especially those in preterm labor, where complete eradication is critical. - **Higher recurrence rates** have been reported with single-dose regimens compared to multi-day treatments. *Clindamycin 300mg orally twice daily for 7 days* - **Oral clindamycin** is an alternative treatment for bacterial vaginosis, but **metronidazole** is often preferred as a first-line option due to its efficacy and safety profile in pregnancy. - The patient's condition of **preterm labor** would generally favor the most established and safest first-line treatment. *Clindamycin 5g vaginal cream for 7 days* - **Vaginal clindamycin cream** is an effective treatment for bacterial vaginosis, but in a patient with **preterm labor**, an **oral systemic antibiotic** is often preferred to ensure adequate tissue penetration and reduce the risk of ascending infection affecting the uterus. - Vaginal creams might be less effective in preventing obstetric complications associated with BV compared to oral therapy in high-risk pregnancies.
Question 7: A multigravida woman in labor room, after delivery and placenta removal, uncontrolled bleeding was seen. What is the most common cause of PPH in this woman?
- A. Clotting factor deficiency
- B. Atony (Correct Answer)
- C. Traumatic PPH
- D. Retained tissues
Explanation: ***Atonic*** - **Uterine atony** is the most common cause of **postpartum hemorrhage (PPH)**, accounting for approximately 70-80% of cases. The uterus fails to contract adequately after placental delivery, leading to continuous bleeding from the placental bed. - Risk factors for uterine atony include multiparity, prolonged labor, rapid labor, polyhydramnios, and multiple gestations, which can lead to overdistension and fatigue of the uterine muscle. *Clotting factor deficiency* - While **coagulopathies** (clotting factor deficiencies) can cause PPH, they are a less common primary cause than uterine atony. - This cause would be suspected if there is a history of bleeding disorders, liver disease, or if PPH persists despite a well-contracted uterus. *Traumatic PPH* - **Traumatic PPH** results from lacerations of the cervix, vagina, or perineum, or from uterine rupture. These are less common than uterine atony. - This cause is typically suspected when the uterus feels firm but bleeding continues, or when visible trauma is present. *Retained tissues* - **Retained placental tissue** can prevent the uterus from contracting effectively, leading to PPH. However, it is less common than atony. - This cause is usually identified by the presence of placental fragments or membranes in the uterine cavity upon examination.
Question 8: A woman at 30 weeks of gestation is diagnosed with deep vein thrombosis (DVT). Which of the following is the most appropriate treatment for this patient?
- A. Warfarin
- B. Low Molecular Weight Heparin (LMWH) (Correct Answer)
- C. Apixaban
- D. Fondaparinux
Explanation: ***Low Molecular Weight Heparin (LMWH)*** - **LMWH** is the preferred anticoagulant for DVT during pregnancy because it does **not cross the placenta**, making it safe for the fetus. - It also has a **predictable anticoagulant response** and a lower risk of **heparin-induced thrombocytopenia (HIT)** compared to unfractionated heparin. *Warfarin* - **Warfarin is teratogenic**, especially during the first trimester, and can cause **fetal warfarin syndrome**, which includes skeletal and central nervous system abnormalities. - It can also lead to **fetal bleeding** and miscarriage at any stage of pregnancy. *Apixaban* - **Apixaban** is a **direct oral anticoagulant (DOAC)**, and its safety in pregnancy has not been established. - There is insufficient data regarding its **placental transfer** and potential fetal effects, making its use generally contraindicated in pregnant women. *Fondaparinux* - While **fondaparinux** is an indirect Factor Xa inhibitor and might be considered in cases of heparin allergy or intolerance, its **safety profile in pregnancy is not as well-established** as LMWH. - It is generally reserved for situations where LMWH cannot be used, and its use requires careful consideration due to limited data.
Question 9: Commonest cause for puerperal sepsis is :
- A. Gonococci
- B. Staphylococci
- C. Streptococci (Correct Answer)
- D. Anaerobes
Explanation: ***Streptococci*** - **Streptococci**, particularly **Group A Streptococcus (GAS/Streptococcus pyogenes)** and **Group B Streptococcus (GBS)**, are the **most common causative organisms** of puerperal sepsis in modern obstetric practice. - **Group A Streptococcus** causes severe, rapidly progressive puerperal sepsis with high morbidity and is the **leading bacterial cause** historically and currently. - **Group B Streptococcus** commonly colonizes the genital tract and frequently causes postpartum endometritis and sepsis. - These organisms can invade through the **placental site** and **cervical/vaginal lacerations** during delivery. *Anaerobes* - **Anaerobic bacteria** (e.g., *Bacteroides fragilis*, anaerobic streptococci) are important pathogens but typically cause **polymicrobial infections** rather than being the single most common cause. - They thrive in devitalized tissue and are often isolated **in combination with aerobic organisms**. - While significant in complicated cases, they are **not the most common single cause** in contemporary practice. *Staphylococci* - **Staphylococcus aureus** typically causes **wound infections** (cesarean section sites), **mastitis**, and occasionally toxic shock syndrome. - They are less commonly the primary cause of intrauterine puerperal sepsis compared to streptococci. *Gonococci* - **Neisseria gonorrhoeae** causes **pelvic inflammatory disease (PID)** and can lead to postpartum endometritis in untreated cases. - It is **not a common cause** of puerperal sepsis as most pregnant women are screened and treated during antenatal care. - More associated with **sexually transmitted infections** than typical postpartum infections.
Question 10: What is the primary use of prophylactic methergin?
- A. None of the options
- B. Induction of labour
- C. Induction of abortion
- D. To stop excess bleeding from uterus (Correct Answer)
Explanation: ***To stop excess bleeding from uterus*** - **Methergin (Methylergonovine)** is an **ergot alkaloid** that causes strong contractions of the **uterus**. - Its primary prophylactic use is to **prevent or treat postpartum hemorrhage** by contracting the uterus and compressing blood vessels. *Induction of labour* - **Methergin** is generally **contraindicated for labor induction** as its potent, sustained contractions can cause **hypertonic uterine dysfunction** and fetal distress. - **Oxytocin** is the preferred agent for **labor induction** due to its more physiological contraction pattern. *Induction of abortion* - While methergin can cause uterine contractions, it is **not the primary agent for abortion induction**. - **Prostaglandins (e.g., misoprostol)** and other pharmacological agents are typically used in combination for **medical abortion**. *None of the options* - This option is incorrect because **stopping excess uterine bleeding** is indeed a primary use of prophylactic methergin, particularly in the postpartum period. - The other options describe situations where methergin is either not indicated or is a secondary/contraindicated choice.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free