POSTPARTUM HEMORRHAGE ACTUAL FINAL EXAM PAPER
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔What is blood loss > 500 mL in a vaginal delivery considered? - ✔✔Abnormal and
should prompt a physician to further investigate it's cause.
✔✔What is a 25% blood loss in a pregnant patient? - ✔✔up to 1500 mL
✔✔What are common causes of secondary PPH? - ✔✔1. retained POC
2. Subinvolution of the placental site
3. Infection
4. Inherited coagulation defects (i.e. vWF)
✔✔What are the three active components of managing a PPH? - ✔✔1. Uterine
massage
2. Oxytocin
3. traction on the umbilical cord
✔✔What is considered a grand multip? What is considered to be an increased risk
factor for PPH? - ✔✔Grand Multip > or equal to 5 vaginal deliveries
> 4 deliveries increases your risk of PPH
✔✔What percentage of PPH is caused by uterine atony? - ✔✔70-80%
✔✔what is an indication for surgical intervention in a suspected hematoma? - ✔✔Most
can be treated conservatively if NOT rapidly expanding or associated with rapid change
in vital signs. (which may be one of the only signs of a hematoma forming)
✔✔What is the utility of a TVUS to look at the endometrial stripe? - ✔✔To identify a
possible retained POC
✔✔What are two coagulopathies to consider that may complicate PPH? - ✔✔1.
Placental Abruption
2. AFE
✔✔What is the classical findings associated with placental abruption? - ✔✔1. uterine
tachysystole (high frequency and low amplitude)
2. abdominal pain
3. vaginal bleeding
✔✔What is the reasoning for uterine atony associated with placental abruption? -
✔✔The abruption leads to bleeding into the myometrium (Couvelaire sign) --> this leads
to DIC, hypofibringoenemia
, ✔✔What is the common triad found with a AFE? - ✔✔1. Hemodynamic compromise
2. Resp Compromise
3. DIC
✔✔When is TXA indicated for prophylactic use? - ✔✔Only in research at this time,
insufficient evidence to support prophylactic use in clinical care
✔✔When is TXA indicated? - ✔✔When other medical methods have failed and ideally
within 3 hr of birth.
✔✔Why do we not IV push oxytocin? - ✔✔because of the risk of hypotension.
✔✔What is the dose for oxytocin? - ✔✔10-40 units per 500-1000 mL OR 10 units IM
✔✔What are CI to methergine? - ✔✔PEC, HTN, cardiovascular disease
✔✔what is the risk associated with prior c-section and a placenta previa for an accreta?
- ✔✔1 prior c-section 3%
2: 11%
3: 40%
4: 61%
✔✔What did one study find the risk for accreta to be with a prior c-section without a
previa? - ✔✔0.2,0.3, 0.6, 2.1, 2.3, 6.7
✔✔What is considered a massive transfusion? - ✔✔> or equal 10 units in 24 hours
4 units in one hour with the need for more blood
replacement of complete blood volume
✔✔What is a potential indicator of placental abruption/AFE? - ✔✔low fibrinogen
✔✔What are common lab abnormalities seen with a blood transfusion? -
✔✔hyperkalemia, hypocalcemia and acidosis
✔✔What is the recommended amount of units of pRBC according the American
Association of Blood Banks for stable patients? - ✔✔1 unit and reassess
✔✔What is the threshold for pRBC transfusion? - ✔✔< 7 hgb and symptomatic, if
asymptomatic and hemodynamically stable consider PO or IV iron
✔✔At the 6 week postpartum visit what is the difference between PO and IV iron hgb
levels? - ✔✔none
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔What is blood loss > 500 mL in a vaginal delivery considered? - ✔✔Abnormal and
should prompt a physician to further investigate it's cause.
✔✔What is a 25% blood loss in a pregnant patient? - ✔✔up to 1500 mL
✔✔What are common causes of secondary PPH? - ✔✔1. retained POC
2. Subinvolution of the placental site
3. Infection
4. Inherited coagulation defects (i.e. vWF)
✔✔What are the three active components of managing a PPH? - ✔✔1. Uterine
massage
2. Oxytocin
3. traction on the umbilical cord
✔✔What is considered a grand multip? What is considered to be an increased risk
factor for PPH? - ✔✔Grand Multip > or equal to 5 vaginal deliveries
> 4 deliveries increases your risk of PPH
✔✔What percentage of PPH is caused by uterine atony? - ✔✔70-80%
✔✔what is an indication for surgical intervention in a suspected hematoma? - ✔✔Most
can be treated conservatively if NOT rapidly expanding or associated with rapid change
in vital signs. (which may be one of the only signs of a hematoma forming)
✔✔What is the utility of a TVUS to look at the endometrial stripe? - ✔✔To identify a
possible retained POC
✔✔What are two coagulopathies to consider that may complicate PPH? - ✔✔1.
Placental Abruption
2. AFE
✔✔What is the classical findings associated with placental abruption? - ✔✔1. uterine
tachysystole (high frequency and low amplitude)
2. abdominal pain
3. vaginal bleeding
✔✔What is the reasoning for uterine atony associated with placental abruption? -
✔✔The abruption leads to bleeding into the myometrium (Couvelaire sign) --> this leads
to DIC, hypofibringoenemia
, ✔✔What is the common triad found with a AFE? - ✔✔1. Hemodynamic compromise
2. Resp Compromise
3. DIC
✔✔When is TXA indicated for prophylactic use? - ✔✔Only in research at this time,
insufficient evidence to support prophylactic use in clinical care
✔✔When is TXA indicated? - ✔✔When other medical methods have failed and ideally
within 3 hr of birth.
✔✔Why do we not IV push oxytocin? - ✔✔because of the risk of hypotension.
✔✔What is the dose for oxytocin? - ✔✔10-40 units per 500-1000 mL OR 10 units IM
✔✔What are CI to methergine? - ✔✔PEC, HTN, cardiovascular disease
✔✔what is the risk associated with prior c-section and a placenta previa for an accreta?
- ✔✔1 prior c-section 3%
2: 11%
3: 40%
4: 61%
✔✔What did one study find the risk for accreta to be with a prior c-section without a
previa? - ✔✔0.2,0.3, 0.6, 2.1, 2.3, 6.7
✔✔What is considered a massive transfusion? - ✔✔> or equal 10 units in 24 hours
4 units in one hour with the need for more blood
replacement of complete blood volume
✔✔What is a potential indicator of placental abruption/AFE? - ✔✔low fibrinogen
✔✔What are common lab abnormalities seen with a blood transfusion? -
✔✔hyperkalemia, hypocalcemia and acidosis
✔✔What is the recommended amount of units of pRBC according the American
Association of Blood Banks for stable patients? - ✔✔1 unit and reassess
✔✔What is the threshold for pRBC transfusion? - ✔✔< 7 hgb and symptomatic, if
asymptomatic and hemodynamically stable consider PO or IV iron
✔✔At the 6 week postpartum visit what is the difference between PO and IV iron hgb
levels? - ✔✔none
