Postpartum Hemorrhage: Practice Test 1 (Units 1-7) -
Questions with Correct Answers
100 questions
1. In the United States, hemorrhage accounts for approximately:
A. No pregnancy-related deaths
B. About 1 in 10 pregnancy-related deaths
C. Nearly all pregnancy-related deaths
D. Only deaths after 1 year
Correct Answer: B. About 1 in 10 pregnancy-related deaths
Rationale: CDC maternal mortality review data show hemorrhage is a leading underlying cause of
pregnancy-related deaths, with most occurring within the first week after birth. Mental health conditions
and cardiovascular conditions are other leading causes.
2. Maternal mortality reviews in the United States have found that most hemorrhage-related
deaths are:
A. Unavoidable
B. Caused only by genetic disorders
C. Unrelated to quality of care
D. Preventable, often due to delays in recognition and treatment
Correct Answer: D. Preventable, often due to delays in recognition and treatment
Rationale: Common contributing factors include underestimating blood loss, delayed escalation, delayed
transfusion and lack of protocols, which is why hemorrhage bundles were developed. These deaths are
not inevitable. Systems improvements save lives.
3. The 2025 WHO, FIGO, and ICM consolidated guideline recommends that clinicians act on
postpartum blood loss of:
A. 1,500 mL only
B. Only when the woman faints
C. 300 mL or more when accompanied by abnormal vital signs, as well as 500 mL or more
D. Only when hemoglobin falls below 6 g/dL
Correct Answer: C. 300 mL or more when accompanied by abnormal vital signs, as well as
500 mL or more
Rationale: The updated guideline lowers the action threshold so that bleeding is recognized earlier,
combined with close monitoring and calibrated drapes to measure loss objectively. Waiting for collapse or
very low hemoglobin delays lifesaving treatment. Early detection is a key change.
,4. The four Ts mnemonic for the causes of postpartum hemorrhage stands for:
A. Temperature, Time, Tension, and Tears
B. Tone, Trauma, Tissue, and Thrombin
C. Tone, Tachycardia, Transfusion, and Tissue
D. Twins, Trauma, Thrombosis, and Tone
Correct Answer: B. Tone, Trauma, Tissue, and Thrombin
Rationale: Tone (atony), trauma (lacerations, hematoma, inversion, rupture), tissue (retained placenta or
clots, accreta) and thrombin (coagulopathy) guide a systematic search for the cause. Identifying the cause
directs treatment. The other lists are not the standard mnemonic.
5. Primary postpartum hemorrhage occurs:
A. Between 24 hours and 12 weeks after birth
B. Only during pregnancy
C. Only after 6 months
D. Within the first 24 hours after birth
Correct Answer: D. Within the first 24 hours after birth
Rationale: Most PPH is primary and occurs in the first hours, often from uterine atony. Secondary (late)
PPH occurs from 24 hours up to 12 weeks, usually from retained tissue, infection or subinvolution. The
other time frames are incorrect.
6. Mild gestational thrombocytopenia in pregnancy:
A. Is common, usually with platelets above 70,000 to 100,000 per microL, and rarely causes bleeding
B. Always causes severe hemorrhage
C. Means the woman cannot deliver vaginally
D. Is the same as HELLP syndrome
Correct Answer: A. Is common, usually with platelets above 70,000 to 100,000 per microL, and
rarely causes bleeding
Rationale: Gestational thrombocytopenia results from hemodilution and increased consumption and
typically resolves after birth. Severe thrombocytopenia suggests other causes such as ITP or HELLP,
which raise bleeding risk. It does not contraindicate vaginal birth.
,7. Blood loss of 500 to 999 mL after vaginal birth is considered by ACOG to be:
A. Abnormal and a reason for increased monitoring and evaluation, even though it does not meet the
PPH definition
B. Normal and requiring no attention
C. Always requiring hysterectomy
D. Massive hemorrhage
Correct Answer: A. Abnormal and a reason for increased monitoring and evaluation, even
though it does not meet the PPH definition
Rationale: Blood loss above 500 mL after vaginal birth should prompt closer monitoring, assessment of
the cause and readiness to escalate. It may progress to PPH. Hysterectomy and massive transfusion are
not indicated at this level unless bleeding continues.
8. Cardiac output in pregnancy increases by about:
A. 30 to 50%
B. 5%
C. 200%
D. It decreases
Correct Answer: A. 30 to 50%
Rationale: Higher cardiac output and blood volume meet the needs of the uterus and placenta, and
immediately after birth autotransfusion further increases output. These changes support tolerance of
normal blood loss. It does not decrease.
9. The uterus is supplied mainly by the uterine arteries, branches of the internal iliac arteries,
with additional supply from the:
A. Renal arteries
B. Femoral arteries
C. Coronary arteries
D. Ovarian arteries
Correct Answer: D. Ovarian arteries
Rationale: The uterine and ovarian arteries anastomose, which is important when surgeons perform
stepwise devascularization to control bleeding. The other arteries do not supply the uterus. Collateral flow
explains why single-vessel ligation may not stop bleeding.
, 10. In low-resource settings, PPH deaths are higher partly because of:
A. Universal access to blood banks
B. Births without skilled attendants, lack of uterotonics, limited blood supplies, and delays in reaching
care
C. Lower uterine blood flow
D. Absence of atony
Correct Answer: B. Births without skilled attendants, lack of uterotonics, limited blood
supplies, and delays in reaching care
Rationale: The three delays model describes delays in deciding to seek care, reaching care and receiving
care. Improving access to quality-assured uterotonics, TXA and skilled birth attendants reduces deaths.
Blood supply is often limited.
11. Physiologic anemia of pregnancy occurs because:
A. Plasma volume increases more than red cell mass, diluting hemoglobin
B. Red cell production stops
C. Iron absorption decreases
D. Blood volume falls
Correct Answer: A. Plasma volume increases more than red cell mass, diluting hemoglobin
Rationale: Hemodilution lowers hemoglobin modestly, but true iron deficiency is also common and should
be treated before birth to improve tolerance of blood loss. Red cell mass actually increases. Iron
absorption rises in pregnancy.
12. Before the reVITALize definition, PPH was traditionally defined as blood loss of:
A. More than 100 mL after any birth
B. More than 3,000 mL after any birth
C. Any visible bleeding
D. More than 500 mL after vaginal birth or more than 1,000 mL after cesarean birth
Correct Answer: D. More than 500 mL after vaginal birth or more than 1,000 mL after cesarean
birth
Rationale: These route-specific thresholds are still used internationally, while ACOG adopted a single
1,000 mL threshold with signs of hypovolemia. Inconsistent definitions complicate comparisons of PPH
rates. The other numbers are not standard definitions.
Questions with Correct Answers
100 questions
1. In the United States, hemorrhage accounts for approximately:
A. No pregnancy-related deaths
B. About 1 in 10 pregnancy-related deaths
C. Nearly all pregnancy-related deaths
D. Only deaths after 1 year
Correct Answer: B. About 1 in 10 pregnancy-related deaths
Rationale: CDC maternal mortality review data show hemorrhage is a leading underlying cause of
pregnancy-related deaths, with most occurring within the first week after birth. Mental health conditions
and cardiovascular conditions are other leading causes.
2. Maternal mortality reviews in the United States have found that most hemorrhage-related
deaths are:
A. Unavoidable
B. Caused only by genetic disorders
C. Unrelated to quality of care
D. Preventable, often due to delays in recognition and treatment
Correct Answer: D. Preventable, often due to delays in recognition and treatment
Rationale: Common contributing factors include underestimating blood loss, delayed escalation, delayed
transfusion and lack of protocols, which is why hemorrhage bundles were developed. These deaths are
not inevitable. Systems improvements save lives.
3. The 2025 WHO, FIGO, and ICM consolidated guideline recommends that clinicians act on
postpartum blood loss of:
A. 1,500 mL only
B. Only when the woman faints
C. 300 mL or more when accompanied by abnormal vital signs, as well as 500 mL or more
D. Only when hemoglobin falls below 6 g/dL
Correct Answer: C. 300 mL or more when accompanied by abnormal vital signs, as well as
500 mL or more
Rationale: The updated guideline lowers the action threshold so that bleeding is recognized earlier,
combined with close monitoring and calibrated drapes to measure loss objectively. Waiting for collapse or
very low hemoglobin delays lifesaving treatment. Early detection is a key change.
,4. The four Ts mnemonic for the causes of postpartum hemorrhage stands for:
A. Temperature, Time, Tension, and Tears
B. Tone, Trauma, Tissue, and Thrombin
C. Tone, Tachycardia, Transfusion, and Tissue
D. Twins, Trauma, Thrombosis, and Tone
Correct Answer: B. Tone, Trauma, Tissue, and Thrombin
Rationale: Tone (atony), trauma (lacerations, hematoma, inversion, rupture), tissue (retained placenta or
clots, accreta) and thrombin (coagulopathy) guide a systematic search for the cause. Identifying the cause
directs treatment. The other lists are not the standard mnemonic.
5. Primary postpartum hemorrhage occurs:
A. Between 24 hours and 12 weeks after birth
B. Only during pregnancy
C. Only after 6 months
D. Within the first 24 hours after birth
Correct Answer: D. Within the first 24 hours after birth
Rationale: Most PPH is primary and occurs in the first hours, often from uterine atony. Secondary (late)
PPH occurs from 24 hours up to 12 weeks, usually from retained tissue, infection or subinvolution. The
other time frames are incorrect.
6. Mild gestational thrombocytopenia in pregnancy:
A. Is common, usually with platelets above 70,000 to 100,000 per microL, and rarely causes bleeding
B. Always causes severe hemorrhage
C. Means the woman cannot deliver vaginally
D. Is the same as HELLP syndrome
Correct Answer: A. Is common, usually with platelets above 70,000 to 100,000 per microL, and
rarely causes bleeding
Rationale: Gestational thrombocytopenia results from hemodilution and increased consumption and
typically resolves after birth. Severe thrombocytopenia suggests other causes such as ITP or HELLP,
which raise bleeding risk. It does not contraindicate vaginal birth.
,7. Blood loss of 500 to 999 mL after vaginal birth is considered by ACOG to be:
A. Abnormal and a reason for increased monitoring and evaluation, even though it does not meet the
PPH definition
B. Normal and requiring no attention
C. Always requiring hysterectomy
D. Massive hemorrhage
Correct Answer: A. Abnormal and a reason for increased monitoring and evaluation, even
though it does not meet the PPH definition
Rationale: Blood loss above 500 mL after vaginal birth should prompt closer monitoring, assessment of
the cause and readiness to escalate. It may progress to PPH. Hysterectomy and massive transfusion are
not indicated at this level unless bleeding continues.
8. Cardiac output in pregnancy increases by about:
A. 30 to 50%
B. 5%
C. 200%
D. It decreases
Correct Answer: A. 30 to 50%
Rationale: Higher cardiac output and blood volume meet the needs of the uterus and placenta, and
immediately after birth autotransfusion further increases output. These changes support tolerance of
normal blood loss. It does not decrease.
9. The uterus is supplied mainly by the uterine arteries, branches of the internal iliac arteries,
with additional supply from the:
A. Renal arteries
B. Femoral arteries
C. Coronary arteries
D. Ovarian arteries
Correct Answer: D. Ovarian arteries
Rationale: The uterine and ovarian arteries anastomose, which is important when surgeons perform
stepwise devascularization to control bleeding. The other arteries do not supply the uterus. Collateral flow
explains why single-vessel ligation may not stop bleeding.
, 10. In low-resource settings, PPH deaths are higher partly because of:
A. Universal access to blood banks
B. Births without skilled attendants, lack of uterotonics, limited blood supplies, and delays in reaching
care
C. Lower uterine blood flow
D. Absence of atony
Correct Answer: B. Births without skilled attendants, lack of uterotonics, limited blood
supplies, and delays in reaching care
Rationale: The three delays model describes delays in deciding to seek care, reaching care and receiving
care. Improving access to quality-assured uterotonics, TXA and skilled birth attendants reduces deaths.
Blood supply is often limited.
11. Physiologic anemia of pregnancy occurs because:
A. Plasma volume increases more than red cell mass, diluting hemoglobin
B. Red cell production stops
C. Iron absorption decreases
D. Blood volume falls
Correct Answer: A. Plasma volume increases more than red cell mass, diluting hemoglobin
Rationale: Hemodilution lowers hemoglobin modestly, but true iron deficiency is also common and should
be treated before birth to improve tolerance of blood loss. Red cell mass actually increases. Iron
absorption rises in pregnancy.
12. Before the reVITALize definition, PPH was traditionally defined as blood loss of:
A. More than 100 mL after any birth
B. More than 3,000 mL after any birth
C. Any visible bleeding
D. More than 500 mL after vaginal birth or more than 1,000 mL after cesarean birth
Correct Answer: D. More than 500 mL after vaginal birth or more than 1,000 mL after cesarean
birth
Rationale: These route-specific thresholds are still used internationally, while ACOG adopted a single
1,000 mL threshold with signs of hypovolemia. Inconsistent definitions complicate comparisons of PPH
rates. The other numbers are not standard definitions.
