POSTPARTUM HEMORRHAGE UPDATED EXAMS
PAPER QUESTIONS AND ANSWERS SURE A+
✔✔Why do you check urinary output when watching a hematoma post-partum? -
✔✔make sure it's not compressing the bladder/urethra
✔✔treatment for a uterus inversion - ✔✔manual put back in place, surgery if that
doesn't work
✔✔risk factors for a ruptured uterus - ✔✔1. previous C/S
2. previous uterine surgery
3. congenital abormalities of the uterus
4. placenta accreta
5. vaginal operative deilvery
6. abnormal labor
✔✔presentation of a uterine rupture - ✔✔1. sudden abdominal pain
2. change in abdominal contour
3. non-reassuring fetal heart pattern
✔✔treatment for a uterine rupture - ✔✔hysterectomy
✔✔maternal mortality with a uterine rupture - ✔✔about 1%
, ✔✔fetal mortality with a uterine rupture - ✔✔about 2%
✔✔How does a retained placenta occur? - ✔✔when either the placenta doesn't
separate from the uterus or doesn't get expelled
✔✔risk factors for failure of the placenta to separate - ✔✔1. previous C/S
2. uterine leiomyomata
3. prior uterine curretage
4. succenturiate placental lobe
5. placental problems
✔✔treatment for a retained placenta - ✔✔attempt to remove manually by putting fingers
through cervix (use SL nitro if cervix already constricted)
✔✔succenturiate placenta - ✔✔an extra lobe is attached to the placenta
✔✔How can a succenturiate placenta lead to hemorrhage? - ✔✔1. vessels connecting
the accessory lobe to the main placenta can rupture
2. the accessory lobe can be retained at delivery
✔✔placenta accreta - ✔✔villi attach to the myometrium instead of just the endometrium
✔✔placenta increta - ✔✔penetration into the myometrium by villi
✔✔placenta perceta - ✔✔penetration through the myometrium and even into other
organs
✔✔Why are placenta accreta, increta, and perceta a problem? - ✔✔there is often
separation of part of the placenta while the rest remains intact leading to bleeding
✔✔treatment for placenta accreta, increta, and perceta - ✔✔hysterectomy (curettage or
sequential arterial ligation is appropriate if the woman would like more children)
✔✔What maternal problems can increase the risk of DIC? - ✔✔1. abruptio placenta
2. amniotic fluid embolism
3. sepsis
4. severe pre-eclampsia
✔✔another name for Sheehan syndrome - ✔✔postpartum hypopituitarism
✔✔How does Sheehan syndrome occur? - ✔✔1. pituitary enlarges in pregnancy
2. hypovolemia from PPH can lead to an infarction of pituitary
3. infarction leads to mild to severe hypopituitarism
PAPER QUESTIONS AND ANSWERS SURE A+
✔✔Why do you check urinary output when watching a hematoma post-partum? -
✔✔make sure it's not compressing the bladder/urethra
✔✔treatment for a uterus inversion - ✔✔manual put back in place, surgery if that
doesn't work
✔✔risk factors for a ruptured uterus - ✔✔1. previous C/S
2. previous uterine surgery
3. congenital abormalities of the uterus
4. placenta accreta
5. vaginal operative deilvery
6. abnormal labor
✔✔presentation of a uterine rupture - ✔✔1. sudden abdominal pain
2. change in abdominal contour
3. non-reassuring fetal heart pattern
✔✔treatment for a uterine rupture - ✔✔hysterectomy
✔✔maternal mortality with a uterine rupture - ✔✔about 1%
, ✔✔fetal mortality with a uterine rupture - ✔✔about 2%
✔✔How does a retained placenta occur? - ✔✔when either the placenta doesn't
separate from the uterus or doesn't get expelled
✔✔risk factors for failure of the placenta to separate - ✔✔1. previous C/S
2. uterine leiomyomata
3. prior uterine curretage
4. succenturiate placental lobe
5. placental problems
✔✔treatment for a retained placenta - ✔✔attempt to remove manually by putting fingers
through cervix (use SL nitro if cervix already constricted)
✔✔succenturiate placenta - ✔✔an extra lobe is attached to the placenta
✔✔How can a succenturiate placenta lead to hemorrhage? - ✔✔1. vessels connecting
the accessory lobe to the main placenta can rupture
2. the accessory lobe can be retained at delivery
✔✔placenta accreta - ✔✔villi attach to the myometrium instead of just the endometrium
✔✔placenta increta - ✔✔penetration into the myometrium by villi
✔✔placenta perceta - ✔✔penetration through the myometrium and even into other
organs
✔✔Why are placenta accreta, increta, and perceta a problem? - ✔✔there is often
separation of part of the placenta while the rest remains intact leading to bleeding
✔✔treatment for placenta accreta, increta, and perceta - ✔✔hysterectomy (curettage or
sequential arterial ligation is appropriate if the woman would like more children)
✔✔What maternal problems can increase the risk of DIC? - ✔✔1. abruptio placenta
2. amniotic fluid embolism
3. sepsis
4. severe pre-eclampsia
✔✔another name for Sheehan syndrome - ✔✔postpartum hypopituitarism
✔✔How does Sheehan syndrome occur? - ✔✔1. pituitary enlarges in pregnancy
2. hypovolemia from PPH can lead to an infarction of pituitary
3. infarction leads to mild to severe hypopituitarism
