Postpartum Hemorrhage: Exam 1 - Questions with Correct
Answers
100 questions
1. Postpartum hemorrhage after cesarean birth differs from vaginal birth in that:
A. Bleeding never occurs after cesarean
B. Blood loss may be harder to measure because of amniotic fluid and irrigation, and intra-abdominal
bleeding may be hidden
C. Atony cannot occur
D. The definition requires 3,000 mL
Correct Answer: B. Blood loss may be harder to measure because of amniotic fluid and
irrigation, and intra-abdominal bleeding may be hidden
Rationale: QBL at cesarean subtracts amniotic fluid and irrigation and weighs sponges, and concealed
bleeding into the abdomen or broad ligament may appear only as instability. Atony can occur after
cesarean. The ACOG threshold is 1,000 mL for both routes.
2. A maternal near miss refers to:
A. A routine uncomplicated birth
B. A woman who nearly died from a severe complication but survived
C. A missed prenatal appointment
D. A minor laceration
Correct Answer: B. A woman who nearly died from a severe complication but survived
Rationale: Near-miss reviews, often involving hemorrhage, provide valuable information to improve care
because they are more common than deaths. They are reviewed alongside deaths in quality programs.
Routine births are not near misses.
3. Severe hemorrhage can cause acute kidney injury because:
A. Blood loss increases kidney blood flow
B. Kidneys are unaffected by shock
C. Fluids always protect the kidneys completely
D. Reduced renal perfusion leads to ischemic damage
Correct Answer: D. Reduced renal perfusion leads to ischemic damage
Rationale: Hypovolemia reduces renal blood flow, initially causing prerenal azotemia and, if prolonged,
acute tubular necrosis. Monitoring urine output is part of hemorrhage care. Adequate resuscitation
reduces risk but may not prevent all injury.
,4. A key reason postpartum hemorrhage can progress rapidly is that:
A. Bleeding always stops on its own
B. Uterine blood flow is very high, so bleeding can exceed 500 mL within minutes
C. The uterus receives little blood
D. Clotting is impaired in all postpartum women
Correct Answer: B. Uterine blood flow is very high, so bleeding can exceed 500 mL within
minutes
Rationale: Because flow to the uterus is so great, a relaxed uterus or arterial injury can cause massive
loss quickly, so delays of even minutes matter. Bleeding does not reliably stop on its own. Most women
have normal clotting.
5. The most common cause of postpartum hemorrhage is:
A. Genital tract lacerations
B. Uterine atony
C. Retained placenta
D. Inherited bleeding disorders
Correct Answer: B. Uterine atony
Rationale: Atony accounts for about 70 to 80% of PPH because the uterus fails to contract and compress
the spiral arteries at the placental site. Trauma, retained tissue and coagulopathy are less common
causes. Treatment therefore begins with measures to restore uterine tone.
6. Immediately after birth, uterine contraction returns about 500 mL of blood from the
uteroplacental circulation to the maternal circulation. This is called:
A. Autotransfusion
B. Hemodilution
C. Hemoconcentration
D. Fibrinolysis
Correct Answer: A. Autotransfusion
Rationale: Autotransfusion helps offset normal delivery blood loss and increases cardiac output in the
early postpartum period. It is one reason women tolerate typical losses. It can stress women with heart
disease.
,7. The global rate of postpartum hemorrhage is estimated to affect about:
A. 1 in 10,000 births
B. Every birth
C. 1 in 10 or more births using the 500 mL threshold
D. 1 in 1 million births
Correct Answer: C. 1 in 10 or more births using the 500 mL threshold
Rationale: Estimates vary by definition and measurement, but PPH is a common complication; objective
measurement often reveals higher rates than visual estimates. It is not rare, which is why every birthing
unit must be prepared.
8. Hemorrhage remains a leading cause of maternal ICU admission because:
A. ICU admission is routine after all births
B. Only infections require ICU care
C. Massive bleeding can cause shock, organ dysfunction, and need for intensive monitoring
D. Bleeding rarely affects organ function
Correct Answer: C. Massive bleeding can cause shock, organ dysfunction, and need for
intensive monitoring
Rationale: Massive transfusion, coagulopathy and organ failure often need intensive care. Most births do
not require ICU admission. Hemorrhage commonly affects organ function.
9. Fetal macrosomia increases hemorrhage risk because of:
A. Uterine overdistension and increased risk of lacerations and shoulder dystocia maneuvers
B. Reduced uterine size
C. Faster third stage
D. Lower risk of trauma
Correct Answer: A. Uterine overdistension and increased risk of lacerations and shoulder
dystocia maneuvers
Rationale: A large baby stretches the uterus and can cause perineal and cervical trauma during birth.
Preparation and careful inspection are important. It does not shorten the third stage.
, 10. Women with thrombocytopenia below 50,000 per microL near delivery are at risk because:
A. Platelets are essential for clot formation, and low counts increase bleeding and limit neuraxial
anesthesia
B. Platelets prevent uterine contraction
C. Low platelets cause hypertension
D. They have no effect on bleeding
Correct Answer: A. Platelets are essential for clot formation, and low counts increase
bleeding and limit neuraxial anesthesia
Rationale: Severe thrombocytopenia from ITP, HELLP or other causes requires planning, possible
platelet transfusion and anesthesia consultation. Neuraxial techniques may be unsafe at low counts.
Platelets do not affect contraction directly.
11. Preeclampsia and HELLP syndrome increase hemorrhage risk partly because of:
A. Thrombocytopenia, coagulopathy, and associated medications such as magnesium
B. Increased platelet production
C. Reduced blood pressure
D. Strengthened uterine contractions
Correct Answer: A. Thrombocytopenia, coagulopathy, and associated medications such as
magnesium
Rationale: HELLP can cause low platelets and DIC, and preeclampsia is associated with abruption.
These conditions also limit some uterotonic choices, such as methylergonovine. They do not strengthen
contractions.
12. Maternal sepsis around the time of birth can increase hemorrhage risk because it:
A. Strengthens clotting
B. Can trigger DIC and impair uterine contractility
C. Prevents bleeding
D. Increases uterine tone
Correct Answer: B. Can trigger DIC and impair uterine contractility
Rationale: Systemic infection activates coagulation and consumes factors, while inflammation affects the
myometrium. Sepsis and hemorrhage together are especially dangerous. Early recognition of both is
needed.
Answers
100 questions
1. Postpartum hemorrhage after cesarean birth differs from vaginal birth in that:
A. Bleeding never occurs after cesarean
B. Blood loss may be harder to measure because of amniotic fluid and irrigation, and intra-abdominal
bleeding may be hidden
C. Atony cannot occur
D. The definition requires 3,000 mL
Correct Answer: B. Blood loss may be harder to measure because of amniotic fluid and
irrigation, and intra-abdominal bleeding may be hidden
Rationale: QBL at cesarean subtracts amniotic fluid and irrigation and weighs sponges, and concealed
bleeding into the abdomen or broad ligament may appear only as instability. Atony can occur after
cesarean. The ACOG threshold is 1,000 mL for both routes.
2. A maternal near miss refers to:
A. A routine uncomplicated birth
B. A woman who nearly died from a severe complication but survived
C. A missed prenatal appointment
D. A minor laceration
Correct Answer: B. A woman who nearly died from a severe complication but survived
Rationale: Near-miss reviews, often involving hemorrhage, provide valuable information to improve care
because they are more common than deaths. They are reviewed alongside deaths in quality programs.
Routine births are not near misses.
3. Severe hemorrhage can cause acute kidney injury because:
A. Blood loss increases kidney blood flow
B. Kidneys are unaffected by shock
C. Fluids always protect the kidneys completely
D. Reduced renal perfusion leads to ischemic damage
Correct Answer: D. Reduced renal perfusion leads to ischemic damage
Rationale: Hypovolemia reduces renal blood flow, initially causing prerenal azotemia and, if prolonged,
acute tubular necrosis. Monitoring urine output is part of hemorrhage care. Adequate resuscitation
reduces risk but may not prevent all injury.
,4. A key reason postpartum hemorrhage can progress rapidly is that:
A. Bleeding always stops on its own
B. Uterine blood flow is very high, so bleeding can exceed 500 mL within minutes
C. The uterus receives little blood
D. Clotting is impaired in all postpartum women
Correct Answer: B. Uterine blood flow is very high, so bleeding can exceed 500 mL within
minutes
Rationale: Because flow to the uterus is so great, a relaxed uterus or arterial injury can cause massive
loss quickly, so delays of even minutes matter. Bleeding does not reliably stop on its own. Most women
have normal clotting.
5. The most common cause of postpartum hemorrhage is:
A. Genital tract lacerations
B. Uterine atony
C. Retained placenta
D. Inherited bleeding disorders
Correct Answer: B. Uterine atony
Rationale: Atony accounts for about 70 to 80% of PPH because the uterus fails to contract and compress
the spiral arteries at the placental site. Trauma, retained tissue and coagulopathy are less common
causes. Treatment therefore begins with measures to restore uterine tone.
6. Immediately after birth, uterine contraction returns about 500 mL of blood from the
uteroplacental circulation to the maternal circulation. This is called:
A. Autotransfusion
B. Hemodilution
C. Hemoconcentration
D. Fibrinolysis
Correct Answer: A. Autotransfusion
Rationale: Autotransfusion helps offset normal delivery blood loss and increases cardiac output in the
early postpartum period. It is one reason women tolerate typical losses. It can stress women with heart
disease.
,7. The global rate of postpartum hemorrhage is estimated to affect about:
A. 1 in 10,000 births
B. Every birth
C. 1 in 10 or more births using the 500 mL threshold
D. 1 in 1 million births
Correct Answer: C. 1 in 10 or more births using the 500 mL threshold
Rationale: Estimates vary by definition and measurement, but PPH is a common complication; objective
measurement often reveals higher rates than visual estimates. It is not rare, which is why every birthing
unit must be prepared.
8. Hemorrhage remains a leading cause of maternal ICU admission because:
A. ICU admission is routine after all births
B. Only infections require ICU care
C. Massive bleeding can cause shock, organ dysfunction, and need for intensive monitoring
D. Bleeding rarely affects organ function
Correct Answer: C. Massive bleeding can cause shock, organ dysfunction, and need for
intensive monitoring
Rationale: Massive transfusion, coagulopathy and organ failure often need intensive care. Most births do
not require ICU admission. Hemorrhage commonly affects organ function.
9. Fetal macrosomia increases hemorrhage risk because of:
A. Uterine overdistension and increased risk of lacerations and shoulder dystocia maneuvers
B. Reduced uterine size
C. Faster third stage
D. Lower risk of trauma
Correct Answer: A. Uterine overdistension and increased risk of lacerations and shoulder
dystocia maneuvers
Rationale: A large baby stretches the uterus and can cause perineal and cervical trauma during birth.
Preparation and careful inspection are important. It does not shorten the third stage.
, 10. Women with thrombocytopenia below 50,000 per microL near delivery are at risk because:
A. Platelets are essential for clot formation, and low counts increase bleeding and limit neuraxial
anesthesia
B. Platelets prevent uterine contraction
C. Low platelets cause hypertension
D. They have no effect on bleeding
Correct Answer: A. Platelets are essential for clot formation, and low counts increase
bleeding and limit neuraxial anesthesia
Rationale: Severe thrombocytopenia from ITP, HELLP or other causes requires planning, possible
platelet transfusion and anesthesia consultation. Neuraxial techniques may be unsafe at low counts.
Platelets do not affect contraction directly.
11. Preeclampsia and HELLP syndrome increase hemorrhage risk partly because of:
A. Thrombocytopenia, coagulopathy, and associated medications such as magnesium
B. Increased platelet production
C. Reduced blood pressure
D. Strengthened uterine contractions
Correct Answer: A. Thrombocytopenia, coagulopathy, and associated medications such as
magnesium
Rationale: HELLP can cause low platelets and DIC, and preeclampsia is associated with abruption.
These conditions also limit some uterotonic choices, such as methylergonovine. They do not strengthen
contractions.
12. Maternal sepsis around the time of birth can increase hemorrhage risk because it:
A. Strengthens clotting
B. Can trigger DIC and impair uterine contractility
C. Prevents bleeding
D. Increases uterine tone
Correct Answer: B. Can trigger DIC and impair uterine contractility
Rationale: Systemic infection activates coagulation and consumes factors, while inflammation affects the
myometrium. Sepsis and hemorrhage together are especially dangerous. Early recognition of both is
needed.
