HEI OBSTETRIC EMERGENCIES
EXAM (2026 Edition)|| Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
SECTION A: Postpartum Hemorrhage (PPH) – Questions 1–15
1. A primigravida delivers a 4.2 kg infant vaginally. 15 minutes later, the uterus is
boggy and there is heavy vaginal bleeding. What is the MOST likely cause?
a) Genital tract laceration
b) Uterine rupture
c) Retained placenta
d) Uterine atony
Rationale: Uterine atony is the leading cause of PPH (70–80%), especially after
macrosomia, overdistension, or prolonged labor.
2. First-line medical management of atonic PPH includes:
a) Oxytocin 10 IU IM
b) Misoprostol 800 mcg sublingual
c) Tranexamic acid 1 g IV
d) Ergotamine 0.2 mg IM
Rationale: Oxytocin is the WHO-recommended first-line uterotonic. Misoprostol
is second-line; ergotamine is contraindicated in hypertension.
3. A patient with PPH receives TXA. The optimal timing for maximum benefit is:
a) After 3 hours of bleeding
b) Within 3 hours of delivery
c) Only after failure of surgery
d) Within 6 hours of delivery
,Rationale: WOMAN trial data (updated 2024) confirms TXA reduces death from
bleeding if given within 3 hours of birth.
4. Which of the following is NOT a risk factor for uterine atony?
a) Chorioamnionitis
b) Magnesium sulfate use
c) Epidural analgesia
d) Prolonged labor
Rationale: Epidural is not independently associated with atony. Prolonged labor,
chorioamnionitis, and MgSO4 are risk factors.
5. The E-MOTIVE trial (2023) for PPH management emphasizes:
a) Hysterectomy as first-line
b) Early bundled care (uterotonics, massage, TXA, fluids)
c) Delayed cord clamping
d) Avoidance of intrauterine balloon tamponade
Rationale: E-MOTIVE showed bundled care within 15 min reduces severe PPH by
60%.
6. A patient develops PPH with a firm uterus. What should be suspected?
a) Uterine atony
b) Lower genital tract laceration
c) Coagulopathy
d) Retained products
Rationale: Firm uterus + bleeding = trauma (lacerations, rupture) until proven
otherwise.
7. Intrauterine balloon tamponade failure after 30 minutes indicates:
a) Repeat balloon placement
b) Proceed to surgical hemostasis (e.g., uterine compression sutures)
c) Discharge home
d) Double dose oxytocin
Rationale: Failure of balloon requires surgical intervention (B-Lynch, Hayman
sutures, or hysterectomy in 2026 guidelines).
8. Recommended dose of misoprostol for PPH is:
a) 200 mcg sublingual
b) 800 mcg sublingual
c) 400 mcg rectal
d) 1000 mcg oral
, Rationale: 800 mcg SL is absorbed fastest in atonic PPH (off-label but standard of
care).
9. Massive transfusion protocol in PPH should activate when:
a) Blood loss >500 mL
b) Hemoglobin drops by 2 g/dL or hemodynamic instability
c) Platelets <150,000
d) Fibrinogen >4 g/L
Rationale: RCOG 2026: activate MTP with >1500 mL loss or shock index >0.9.
10. Which sign suggests impending coagulopathy in PPH?
a) Oozing from IV sites or gums
b) Tachycardia >100
c) Uterine atony
d) Oliguria
Rationale: Mucosal oozing = consumptive coagulopathy (DIC) from prolonged
shock/tissue factor release.
11. A patient with PPH receives 4 units RBC, 4 units FFP, and cryoprecipitate.
Fibrinogen level is 1.2 g/L. Next step:
a) Give additional cryoprecipitate or fibrinogen concentrate
b) Platelet transfusion
c) Stop all products
d) Recombinant factor VIIa
Rationale: Fibrinogen <2 g/L in PPH requires fibrinogen replacement (cryo or
concentrate) per 2026 guidelines.
12. Recombinant factor VIIa in PPH is:
a) First-line treatment
b) Used only in refractory bleeding hemophilia patients
c) Indicated for all PPH
d) Safer than TXA
Rationale: rFVIIa increases thrombosis risk; reserved for specific coagulopathies,
not routine PPH.
13. Which uterotonic is contraindicated in preeclampsia?
a) Oxytocin
b) Carbetocin
c) Ergometrine
d) Misoprostol
EXAM (2026 Edition)|| Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
SECTION A: Postpartum Hemorrhage (PPH) – Questions 1–15
1. A primigravida delivers a 4.2 kg infant vaginally. 15 minutes later, the uterus is
boggy and there is heavy vaginal bleeding. What is the MOST likely cause?
a) Genital tract laceration
b) Uterine rupture
c) Retained placenta
d) Uterine atony
Rationale: Uterine atony is the leading cause of PPH (70–80%), especially after
macrosomia, overdistension, or prolonged labor.
2. First-line medical management of atonic PPH includes:
a) Oxytocin 10 IU IM
b) Misoprostol 800 mcg sublingual
c) Tranexamic acid 1 g IV
d) Ergotamine 0.2 mg IM
Rationale: Oxytocin is the WHO-recommended first-line uterotonic. Misoprostol
is second-line; ergotamine is contraindicated in hypertension.
3. A patient with PPH receives TXA. The optimal timing for maximum benefit is:
a) After 3 hours of bleeding
b) Within 3 hours of delivery
c) Only after failure of surgery
d) Within 6 hours of delivery
,Rationale: WOMAN trial data (updated 2024) confirms TXA reduces death from
bleeding if given within 3 hours of birth.
4. Which of the following is NOT a risk factor for uterine atony?
a) Chorioamnionitis
b) Magnesium sulfate use
c) Epidural analgesia
d) Prolonged labor
Rationale: Epidural is not independently associated with atony. Prolonged labor,
chorioamnionitis, and MgSO4 are risk factors.
5. The E-MOTIVE trial (2023) for PPH management emphasizes:
a) Hysterectomy as first-line
b) Early bundled care (uterotonics, massage, TXA, fluids)
c) Delayed cord clamping
d) Avoidance of intrauterine balloon tamponade
Rationale: E-MOTIVE showed bundled care within 15 min reduces severe PPH by
60%.
6. A patient develops PPH with a firm uterus. What should be suspected?
a) Uterine atony
b) Lower genital tract laceration
c) Coagulopathy
d) Retained products
Rationale: Firm uterus + bleeding = trauma (lacerations, rupture) until proven
otherwise.
7. Intrauterine balloon tamponade failure after 30 minutes indicates:
a) Repeat balloon placement
b) Proceed to surgical hemostasis (e.g., uterine compression sutures)
c) Discharge home
d) Double dose oxytocin
Rationale: Failure of balloon requires surgical intervention (B-Lynch, Hayman
sutures, or hysterectomy in 2026 guidelines).
8. Recommended dose of misoprostol for PPH is:
a) 200 mcg sublingual
b) 800 mcg sublingual
c) 400 mcg rectal
d) 1000 mcg oral
, Rationale: 800 mcg SL is absorbed fastest in atonic PPH (off-label but standard of
care).
9. Massive transfusion protocol in PPH should activate when:
a) Blood loss >500 mL
b) Hemoglobin drops by 2 g/dL or hemodynamic instability
c) Platelets <150,000
d) Fibrinogen >4 g/L
Rationale: RCOG 2026: activate MTP with >1500 mL loss or shock index >0.9.
10. Which sign suggests impending coagulopathy in PPH?
a) Oozing from IV sites or gums
b) Tachycardia >100
c) Uterine atony
d) Oliguria
Rationale: Mucosal oozing = consumptive coagulopathy (DIC) from prolonged
shock/tissue factor release.
11. A patient with PPH receives 4 units RBC, 4 units FFP, and cryoprecipitate.
Fibrinogen level is 1.2 g/L. Next step:
a) Give additional cryoprecipitate or fibrinogen concentrate
b) Platelet transfusion
c) Stop all products
d) Recombinant factor VIIa
Rationale: Fibrinogen <2 g/L in PPH requires fibrinogen replacement (cryo or
concentrate) per 2026 guidelines.
12. Recombinant factor VIIa in PPH is:
a) First-line treatment
b) Used only in refractory bleeding hemophilia patients
c) Indicated for all PPH
d) Safer than TXA
Rationale: rFVIIa increases thrombosis risk; reserved for specific coagulopathies,
not routine PPH.
13. Which uterotonic is contraindicated in preeclampsia?
a) Oxytocin
b) Carbetocin
c) Ergometrine
d) Misoprostol
