POSTPARTUM HEMORRHAGE EXAM SCRIPT 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
✔✔11. Upon diagnosis or admission of patient with postpartum hemorrhage: - ✔✔•
Trendelenburg - to improve venous return
• Keep warm by providing extra blanket
• Administer oxygen
• Two IV lines as ordered - 1 for fluid and drugs, 1 for possible blood transfusion.
• Blood transfusion is often required if estimated blood loss is > 2,000 ml
✔✔determine consistency, size and position. - ✔✔Palpate fundus
✔✔- for continuous oozing of blood and hematoma formation. - ✔✔Inspect vagina and
perineal area -
✔✔- weigh perineal pads, check blood pool under the hips. - ✔✔Monitor blood loss per
vagina
✔✔are the most significant signs in
hemorrhage. - ✔✔Monitor VS (PR & BP). Tachycardia & Hypotension
✔✔- ↓ urine output signifies - ✔✔↓ blood supply to vital organs.
✔✔- ↓ urine output signifies ↓ blood supply to vital organs. - ✔✔Monitor urine output -
✔✔assess tissue perfusion and oxygen saturation via pulse oximetry. - ✔✔Monitor
tissue perfusion -
✔✔altered LOC that occurs with shock is due to ↓ blood supply to
brain. - ✔✔Assess level of consciousness
✔✔CBC (Hgb and Hct) - ✔✔Lab work
✔✔to detect causes of hemorrhage (retained placental fragments and occult
hematoma) - ✔✔UTZ
✔✔done when embolization of bleeding vessels is to be performed. - ✔✔Angiography
✔✔MANAGEMENT. Priorities in managing postpartum hemorrhage are: - ✔✔1. Call for
help
2. Make a rapid assessment of the woman's condition
3. Find the cause of the bleeding
4. Stop the bleeding
5. Stabilize or resuscitate the woman
, 6. Prevent further bleeding
✔✔• Packing prevents bleeding by tamponade effect.
• Prophylactic antibiotics and oxytocin is administered. Packing is removed after 24-36
hours.
− Monitor concealed hemorrhage (hypotension and tachycardia w/o external bleeding)
− Monitor possible infection (fever and foul vaginal discharge) - ✔✔Uterine packing
✔✔Refers to the failure of the uterus to contract continuously after delivery. -
✔✔UTERINE ATONY
✔✔− Most common cause of PPH. - ✔✔UTERINE ATONY
✔✔Risk Factors / Causes of uterine atony - ✔✔1. Overdistention
2. Complication of labor
3. Uterine relaxing agents
4. Oxytocin given during labor
5. High parity and advanced maternal age
6. Infection
7. Presence of fibroid tumors
8. Over massage of the uterus
9. Retained placental fragments
10. Medical conditions
11. Prolonged 3rd stage of labor
✔✔hydramnios, multiple pregnancy, macrosomia, fibroids - ✔✔Overdistention -
✔✔precipitate labor, prolonged labor, operative delivery - ✔✔Complication of labor -
✔✔Uterine relaxing agents - - ✔✔anesthesia, analgesia, terbutaline, MgSO4
✔✔Infection - ✔✔amnionitis and chorioamnionitis
✔✔that interfere with uterine contractions - ✔✔Presence of fibroid tumors
✔✔results in very strong uterine contractions and eventual fatigue - ✔✔Over massage
of the uterus
✔✔anemia, coagulopathy (blood normally clots within 5 minutes, if fails to
clot within 7 minutes - clotting defect - ✔✔Medical conditions -
✔✔Management in uterine atony - ✔✔1. Massage uterine fundus
2. Keep bladder empty
3. Administer uterotonics
QUESTIONS WITH ANSWERS GRADED A+
✔✔11. Upon diagnosis or admission of patient with postpartum hemorrhage: - ✔✔•
Trendelenburg - to improve venous return
• Keep warm by providing extra blanket
• Administer oxygen
• Two IV lines as ordered - 1 for fluid and drugs, 1 for possible blood transfusion.
• Blood transfusion is often required if estimated blood loss is > 2,000 ml
✔✔determine consistency, size and position. - ✔✔Palpate fundus
✔✔- for continuous oozing of blood and hematoma formation. - ✔✔Inspect vagina and
perineal area -
✔✔- weigh perineal pads, check blood pool under the hips. - ✔✔Monitor blood loss per
vagina
✔✔are the most significant signs in
hemorrhage. - ✔✔Monitor VS (PR & BP). Tachycardia & Hypotension
✔✔- ↓ urine output signifies - ✔✔↓ blood supply to vital organs.
✔✔- ↓ urine output signifies ↓ blood supply to vital organs. - ✔✔Monitor urine output -
✔✔assess tissue perfusion and oxygen saturation via pulse oximetry. - ✔✔Monitor
tissue perfusion -
✔✔altered LOC that occurs with shock is due to ↓ blood supply to
brain. - ✔✔Assess level of consciousness
✔✔CBC (Hgb and Hct) - ✔✔Lab work
✔✔to detect causes of hemorrhage (retained placental fragments and occult
hematoma) - ✔✔UTZ
✔✔done when embolization of bleeding vessels is to be performed. - ✔✔Angiography
✔✔MANAGEMENT. Priorities in managing postpartum hemorrhage are: - ✔✔1. Call for
help
2. Make a rapid assessment of the woman's condition
3. Find the cause of the bleeding
4. Stop the bleeding
5. Stabilize or resuscitate the woman
, 6. Prevent further bleeding
✔✔• Packing prevents bleeding by tamponade effect.
• Prophylactic antibiotics and oxytocin is administered. Packing is removed after 24-36
hours.
− Monitor concealed hemorrhage (hypotension and tachycardia w/o external bleeding)
− Monitor possible infection (fever and foul vaginal discharge) - ✔✔Uterine packing
✔✔Refers to the failure of the uterus to contract continuously after delivery. -
✔✔UTERINE ATONY
✔✔− Most common cause of PPH. - ✔✔UTERINE ATONY
✔✔Risk Factors / Causes of uterine atony - ✔✔1. Overdistention
2. Complication of labor
3. Uterine relaxing agents
4. Oxytocin given during labor
5. High parity and advanced maternal age
6. Infection
7. Presence of fibroid tumors
8. Over massage of the uterus
9. Retained placental fragments
10. Medical conditions
11. Prolonged 3rd stage of labor
✔✔hydramnios, multiple pregnancy, macrosomia, fibroids - ✔✔Overdistention -
✔✔precipitate labor, prolonged labor, operative delivery - ✔✔Complication of labor -
✔✔Uterine relaxing agents - - ✔✔anesthesia, analgesia, terbutaline, MgSO4
✔✔Infection - ✔✔amnionitis and chorioamnionitis
✔✔that interfere with uterine contractions - ✔✔Presence of fibroid tumors
✔✔results in very strong uterine contractions and eventual fatigue - ✔✔Over massage
of the uterus
✔✔anemia, coagulopathy (blood normally clots within 5 minutes, if fails to
clot within 7 minutes - clotting defect - ✔✔Medical conditions -
✔✔Management in uterine atony - ✔✔1. Massage uterine fundus
2. Keep bladder empty
3. Administer uterotonics
