Indiana University-Purdue University-Indianapolis B334
(OB and Family Populations) Exam 1 Questions | 2026/2027 |
Answers Correct | With Complete Solutions
Define Postpartum Hemorrhage (PPH)
(1) cumulative blood loss ≥1000 mL or (2) bleeding associated
with signs/symptoms of hypovolemia within 24 hours of the
birth process regardless of the type of birth (s/s including:
decrease of ≥ 10% in mother's hematocrit, changes in mother's
HR, BP, Sp02%
Primary Postpartum Hemorrhage
significant bleeding within the first 24 after delivery
Secondary (Late) Postpartum Hemorrhage
significant bleeding after the first 24 after delivery
Most common causes of PPH
Tone, Trauma, Tissue, Thrombin
What is Tone's role in PPH?
Lack of uterine tone (aka uterine atony) - soft, spongy, boggy
uterus. and is the MAIN cause of PPH. This generally results in
a slow and steady loss of blood.
Failure of the myometrium to contract after delivery results in
continued bleeding of placental arteries at the point where they
are attached to the uterine wall. (Normal contraction of the
uterus after delivery would result in these arteries being clamped
,shut --> reduced bleeding.)
Uterine atony may be caused by:
repeated distention (multiple pregnancies, overstretching from
multiples), muscles fatigue from prolonged labor, mother unable
to empty bladder, some obstetric medications
How is uterine atony treated?
Fundal massage!!, urinate and/or have catheter placed,
medications (oxytocin), in some cases surgery
What is Trauma's role in PPH?
damage to genital structures: uterus, cervix, vagina, perineum.
may include incision from cesarean, trauma from baby coming
through the vaginal canal, medical instruments (forceps, vacuum
extraction, episiotomy)
Hematoma's may form due to trauma and may go unnoticed for
hours after delivery. s/s of hematoma: severe pain, steady trickle
of bright red blood despite a firmly contracted uterus
treat by applying pressure or stitching lacerations
What is Tissue's role in PPH?
Placental fragments retained in the uterine cavity. The entire
placenta normally separates from the uterine wall in the 3rd
stage of labor, in some cases fragments of the placenta can fail
to separate and stay behind in the uterus.
,Placenta accreda: condition in which the placenta invades the
myometrium so it cannot easily separate. This condition as well
as too much traction on the umbilical cord can both cause the
placenta to be retained, which prevents uterine contractions and
leads to uterine atony.
goal is prevention: make sure the entire placenta comes out in
the first place and/or remove any retained tissue ASAP.
What is Thrombin's role in PPH?
mother has a blood clotting condition that may be genetic (Von
Willebrand disease) or obstetric condition (eclampsia, placental
abruption) which may result in a clotting disorder.
These conditions may cause disseminated intravascular
coagulation (DIC) - conditions that prevent a clot from forming
normally
endometritis
an infection of the lining of the uterus that usually begins as a
localized infection at the placental site but can spread to the
entire endometrium. The highest incidence occurs in women
who gave birth by cesarean after prolonged labor and rupture of
membranes.
endometritis assessments
Assessments of lochia, vital signs, and changes in the woman's
condition continue during treatment.
S/S of endometritis
, Signs of endometritis include fever (usually greater than 38°C
[100.4°F]), increased pulse, chills, anorexia, nausea, fatigue and
lethargy, pelvic pain, uterine tenderness, and foul-smelling,
profuse lochia. Leukocytosis and a markedly increased RBC
sedimentation rate are typical laboratory findings of postpartum
infection. Anemia can also be present. Blood cultures or
intracervical or intrauterine bacterial cultures are not clinically
useful and increase the cost of care
endometritis management
Management of endometritis consists of IV broad-spectrum
antibiotic therapy (clindamycin and gentamicin, cephalosporins,
penicillins) and supportive care, including hydration, rest, and
pain relief. Antibiotic therapy is usually discontinued 24 hours
after the woman is afebrile and asymptomatic
endometritis teaching
Teaching should include side effects of therapy, prevention of
the spread of infection, signs and symptoms of worsening
condition, adherence to the treatment plan, and the need for
follow-up care. Women may need additional support to maintain
mother-infant interactions and breastfeeding.
endometritis comfort measures
cool compresses, warm blankets, perineal care, and sitz baths.
engorgement
due to an increase in blood and lymphatic fluid as milk
production increases. Occurs day 3-5 postpartum- Breasts are
swollen, hard, and painful- Difficult for infant to latch and feed
(OB and Family Populations) Exam 1 Questions | 2026/2027 |
Answers Correct | With Complete Solutions
Define Postpartum Hemorrhage (PPH)
(1) cumulative blood loss ≥1000 mL or (2) bleeding associated
with signs/symptoms of hypovolemia within 24 hours of the
birth process regardless of the type of birth (s/s including:
decrease of ≥ 10% in mother's hematocrit, changes in mother's
HR, BP, Sp02%
Primary Postpartum Hemorrhage
significant bleeding within the first 24 after delivery
Secondary (Late) Postpartum Hemorrhage
significant bleeding after the first 24 after delivery
Most common causes of PPH
Tone, Trauma, Tissue, Thrombin
What is Tone's role in PPH?
Lack of uterine tone (aka uterine atony) - soft, spongy, boggy
uterus. and is the MAIN cause of PPH. This generally results in
a slow and steady loss of blood.
Failure of the myometrium to contract after delivery results in
continued bleeding of placental arteries at the point where they
are attached to the uterine wall. (Normal contraction of the
uterus after delivery would result in these arteries being clamped
,shut --> reduced bleeding.)
Uterine atony may be caused by:
repeated distention (multiple pregnancies, overstretching from
multiples), muscles fatigue from prolonged labor, mother unable
to empty bladder, some obstetric medications
How is uterine atony treated?
Fundal massage!!, urinate and/or have catheter placed,
medications (oxytocin), in some cases surgery
What is Trauma's role in PPH?
damage to genital structures: uterus, cervix, vagina, perineum.
may include incision from cesarean, trauma from baby coming
through the vaginal canal, medical instruments (forceps, vacuum
extraction, episiotomy)
Hematoma's may form due to trauma and may go unnoticed for
hours after delivery. s/s of hematoma: severe pain, steady trickle
of bright red blood despite a firmly contracted uterus
treat by applying pressure or stitching lacerations
What is Tissue's role in PPH?
Placental fragments retained in the uterine cavity. The entire
placenta normally separates from the uterine wall in the 3rd
stage of labor, in some cases fragments of the placenta can fail
to separate and stay behind in the uterus.
,Placenta accreda: condition in which the placenta invades the
myometrium so it cannot easily separate. This condition as well
as too much traction on the umbilical cord can both cause the
placenta to be retained, which prevents uterine contractions and
leads to uterine atony.
goal is prevention: make sure the entire placenta comes out in
the first place and/or remove any retained tissue ASAP.
What is Thrombin's role in PPH?
mother has a blood clotting condition that may be genetic (Von
Willebrand disease) or obstetric condition (eclampsia, placental
abruption) which may result in a clotting disorder.
These conditions may cause disseminated intravascular
coagulation (DIC) - conditions that prevent a clot from forming
normally
endometritis
an infection of the lining of the uterus that usually begins as a
localized infection at the placental site but can spread to the
entire endometrium. The highest incidence occurs in women
who gave birth by cesarean after prolonged labor and rupture of
membranes.
endometritis assessments
Assessments of lochia, vital signs, and changes in the woman's
condition continue during treatment.
S/S of endometritis
, Signs of endometritis include fever (usually greater than 38°C
[100.4°F]), increased pulse, chills, anorexia, nausea, fatigue and
lethargy, pelvic pain, uterine tenderness, and foul-smelling,
profuse lochia. Leukocytosis and a markedly increased RBC
sedimentation rate are typical laboratory findings of postpartum
infection. Anemia can also be present. Blood cultures or
intracervical or intrauterine bacterial cultures are not clinically
useful and increase the cost of care
endometritis management
Management of endometritis consists of IV broad-spectrum
antibiotic therapy (clindamycin and gentamicin, cephalosporins,
penicillins) and supportive care, including hydration, rest, and
pain relief. Antibiotic therapy is usually discontinued 24 hours
after the woman is afebrile and asymptomatic
endometritis teaching
Teaching should include side effects of therapy, prevention of
the spread of infection, signs and symptoms of worsening
condition, adherence to the treatment plan, and the need for
follow-up care. Women may need additional support to maintain
mother-infant interactions and breastfeeding.
endometritis comfort measures
cool compresses, warm blankets, perineal care, and sitz baths.
engorgement
due to an increase in blood and lymphatic fluid as milk
production increases. Occurs day 3-5 postpartum- Breasts are
swollen, hard, and painful- Difficult for infant to latch and feed
