Postpartum Hemorrhage: Exam 2 - Questions with Correct
Answers
100 questions
1. The decidua at the placental site is rich in tissue factor, which:
A. Prevents clotting
B. Causes uterine relaxation
C. Has no role in hemostasis
D. Helps activate the clotting cascade to seal bleeding vessels after separation
Correct Answer: D. Helps activate the clotting cascade to seal bleeding vessels after
separation
Rationale: Tissue factor in the decidua initiates local coagulation, complementing myometrial contraction.
Disruption of normal decidua, as in accreta, contributes to severe bleeding. It promotes clotting.
2. Maternal deaths from hemorrhage are disproportionately higher among which US group?
A. Black women, reflecting structural inequities in care
B. Women with private insurance only
C. Women under 20 only
D. There are no disparities
Correct Answer: A. Black women, reflecting structural inequities in care
Rationale: Black women experience higher rates of severe maternal morbidity and mortality, including
from hemorrhage, related to systemic racism, bias and access to quality care. Equity-focused hemorrhage
protocols help reduce gaps. Disparities are well documented.
3. Postpartum hemorrhage is a leading cause of maternal death worldwide, causing
approximately:
A. About 500 deaths each year
B. About 5 million deaths each year
C. No deaths in the modern era
D. Nearly 45,000 deaths each year
Correct Answer: D. Nearly 45,000 deaths each year
Rationale: WHO and partner agencies report that PPH kills nearly 45,000 women annually, most in low-
and middle-income countries, and most deaths are preventable with timely care. It remains a major
contributor in high-income countries as well.
,4. Physiologic changes of pregnancy that partly protect against blood loss at delivery include:
A. Decreased blood volume
B. Reduced clotting factors
C. Lower cardiac output
D. Increased blood volume by about 40 to 50% and increased clotting factors such as fibrinogen
Correct Answer: D. Increased blood volume by about 40 to 50% and increased clotting factors
such as fibrinogen
Rationale: Plasma volume and red cell mass expand, and pregnancy creates a hypercoagulable state
with higher fibrinogen, preparing for birth. These changes can also mask early hypovolemia, delaying
recognition of hemorrhage. Cardiac output increases in pregnancy.
5. Inconsistent definitions and visual estimation of blood loss can result in:
A. Overreporting of all cases
B. Underreporting of postpartum hemorrhage rates
C. Perfect data accuracy
D. No effect on statistics
Correct Answer: B. Underreporting of postpartum hemorrhage rates
Rationale: When blood loss is underestimated, many PPH cases are not recorded, masking the true
burden. Quantitative measurement and standard definitions improve surveillance. Data are not perfectly
accurate.
6. Endogenous oxytocin helps prevent hemorrhage after birth by:
A. Relaxing the uterus
B. Dilating uterine arteries
C. Reducing clotting factors
D. Stimulating strong, sustained uterine contractions
Correct Answer: D. Stimulating strong, sustained uterine contractions
Rationale: Oxytocin released from the posterior pituitary, enhanced by skin-to-skin contact and
breastfeeding, promotes contraction. Exogenous oxytocin is used for prevention and treatment. It does
not relax the uterus.
,7. After placental separation, the main physiologic mechanism that controls bleeding from the
placental site is:
A. Platelet plug formation alone
B. Vasodilation of the uterine arteries
C. Relaxation of the uterus
D. Contraction and retraction of interlacing myometrial fibers that compress blood vessels (living
ligatures)
Correct Answer: D. Contraction and retraction of interlacing myometrial fibers that compress
blood vessels (living ligatures)
Rationale: The crisscrossing muscle fibers of the uterus act as physiologic ligatures around the spiral
arteries; clotting factors then seal the vessels. When the uterus relaxes, the vessels bleed freely.
Vasodilation and relaxation would increase bleeding.
8. The fourth stage of labor refers to:
A. The period before labor begins
B. The second stage pushing phase
C. The first 1 to 2 hours after delivery of the placenta, a high-risk period for hemorrhage
D. Six weeks postpartum
Correct Answer: C. The first 1 to 2 hours after delivery of the placenta, a high-risk period for
hemorrhage
Rationale: During the fourth stage, frequent assessments of the fundus, bleeding and vital signs detect
early hemorrhage. It is the period of greatest PPH risk. It is not antepartum or a later postpartum period.
9. Assisted reproductive technology pregnancies are associated with increased PPH risk partly
because of:
A. Fewer complications than spontaneous pregnancies
B. Lower rates of cesarean
C. Absence of placental problems
D. Higher rates of multiple gestation, placenta previa, and abnormal placentation
Correct Answer: D. Higher rates of multiple gestation, placenta previa, and abnormal
placentation
Rationale: IVF pregnancies have higher rates of placental abnormalities and multiples. Clinicians include
this history in risk assessment. They are not associated with fewer complications.
, 10. Screening for anemia in pregnancy is typically done:
A. Only after delivery
B. At the first prenatal visit and again in the third trimester
C. Only if bleeding occurs
D. Only once at 40 weeks
Correct Answer: B. At the first prenatal visit and again in the third trimester
Rationale: Repeat screening around 24 to 28 weeks allows time to treat iron deficiency before birth.
Waiting until delivery or bleeding misses the chance to optimize hemoglobin. Ferritin may help identify iron
deficiency.
11. Women with a history of bariatric surgery may have:
A. Guaranteed normal iron levels
B. No nutritional concerns
C. Excess iron
D. Iron deficiency anemia that should be addressed before birth
Correct Answer: D. Iron deficiency anemia that should be addressed before birth
Rationale: Malabsorption after bariatric surgery commonly causes iron and other deficiencies, which can
reduce tolerance of blood loss. IV iron may be needed. Nutritional monitoring is recommended.
12. Hemorrhage risk assessment, as recommended by the AIM and CMQCC bundles, should be
performed:
A. Only after hemorrhage begins
B. On admission to labor and delivery, and repeated as risk changes during labor and before birth
C. Only at the first prenatal visit
D. Only for cesarean births
Correct Answer: B. On admission to labor and delivery, and repeated as risk changes during
labor and before birth
Rationale: Risk assessment at multiple points allows preparation such as type and screen or crossmatch
and ensures resources are ready. Risk can change during labor, for example with prolonged oxytocin or
chorioamnionitis. Waiting until bleeding begins wastes time.
Answers
100 questions
1. The decidua at the placental site is rich in tissue factor, which:
A. Prevents clotting
B. Causes uterine relaxation
C. Has no role in hemostasis
D. Helps activate the clotting cascade to seal bleeding vessels after separation
Correct Answer: D. Helps activate the clotting cascade to seal bleeding vessels after
separation
Rationale: Tissue factor in the decidua initiates local coagulation, complementing myometrial contraction.
Disruption of normal decidua, as in accreta, contributes to severe bleeding. It promotes clotting.
2. Maternal deaths from hemorrhage are disproportionately higher among which US group?
A. Black women, reflecting structural inequities in care
B. Women with private insurance only
C. Women under 20 only
D. There are no disparities
Correct Answer: A. Black women, reflecting structural inequities in care
Rationale: Black women experience higher rates of severe maternal morbidity and mortality, including
from hemorrhage, related to systemic racism, bias and access to quality care. Equity-focused hemorrhage
protocols help reduce gaps. Disparities are well documented.
3. Postpartum hemorrhage is a leading cause of maternal death worldwide, causing
approximately:
A. About 500 deaths each year
B. About 5 million deaths each year
C. No deaths in the modern era
D. Nearly 45,000 deaths each year
Correct Answer: D. Nearly 45,000 deaths each year
Rationale: WHO and partner agencies report that PPH kills nearly 45,000 women annually, most in low-
and middle-income countries, and most deaths are preventable with timely care. It remains a major
contributor in high-income countries as well.
,4. Physiologic changes of pregnancy that partly protect against blood loss at delivery include:
A. Decreased blood volume
B. Reduced clotting factors
C. Lower cardiac output
D. Increased blood volume by about 40 to 50% and increased clotting factors such as fibrinogen
Correct Answer: D. Increased blood volume by about 40 to 50% and increased clotting factors
such as fibrinogen
Rationale: Plasma volume and red cell mass expand, and pregnancy creates a hypercoagulable state
with higher fibrinogen, preparing for birth. These changes can also mask early hypovolemia, delaying
recognition of hemorrhage. Cardiac output increases in pregnancy.
5. Inconsistent definitions and visual estimation of blood loss can result in:
A. Overreporting of all cases
B. Underreporting of postpartum hemorrhage rates
C. Perfect data accuracy
D. No effect on statistics
Correct Answer: B. Underreporting of postpartum hemorrhage rates
Rationale: When blood loss is underestimated, many PPH cases are not recorded, masking the true
burden. Quantitative measurement and standard definitions improve surveillance. Data are not perfectly
accurate.
6. Endogenous oxytocin helps prevent hemorrhage after birth by:
A. Relaxing the uterus
B. Dilating uterine arteries
C. Reducing clotting factors
D. Stimulating strong, sustained uterine contractions
Correct Answer: D. Stimulating strong, sustained uterine contractions
Rationale: Oxytocin released from the posterior pituitary, enhanced by skin-to-skin contact and
breastfeeding, promotes contraction. Exogenous oxytocin is used for prevention and treatment. It does
not relax the uterus.
,7. After placental separation, the main physiologic mechanism that controls bleeding from the
placental site is:
A. Platelet plug formation alone
B. Vasodilation of the uterine arteries
C. Relaxation of the uterus
D. Contraction and retraction of interlacing myometrial fibers that compress blood vessels (living
ligatures)
Correct Answer: D. Contraction and retraction of interlacing myometrial fibers that compress
blood vessels (living ligatures)
Rationale: The crisscrossing muscle fibers of the uterus act as physiologic ligatures around the spiral
arteries; clotting factors then seal the vessels. When the uterus relaxes, the vessels bleed freely.
Vasodilation and relaxation would increase bleeding.
8. The fourth stage of labor refers to:
A. The period before labor begins
B. The second stage pushing phase
C. The first 1 to 2 hours after delivery of the placenta, a high-risk period for hemorrhage
D. Six weeks postpartum
Correct Answer: C. The first 1 to 2 hours after delivery of the placenta, a high-risk period for
hemorrhage
Rationale: During the fourth stage, frequent assessments of the fundus, bleeding and vital signs detect
early hemorrhage. It is the period of greatest PPH risk. It is not antepartum or a later postpartum period.
9. Assisted reproductive technology pregnancies are associated with increased PPH risk partly
because of:
A. Fewer complications than spontaneous pregnancies
B. Lower rates of cesarean
C. Absence of placental problems
D. Higher rates of multiple gestation, placenta previa, and abnormal placentation
Correct Answer: D. Higher rates of multiple gestation, placenta previa, and abnormal
placentation
Rationale: IVF pregnancies have higher rates of placental abnormalities and multiples. Clinicians include
this history in risk assessment. They are not associated with fewer complications.
, 10. Screening for anemia in pregnancy is typically done:
A. Only after delivery
B. At the first prenatal visit and again in the third trimester
C. Only if bleeding occurs
D. Only once at 40 weeks
Correct Answer: B. At the first prenatal visit and again in the third trimester
Rationale: Repeat screening around 24 to 28 weeks allows time to treat iron deficiency before birth.
Waiting until delivery or bleeding misses the chance to optimize hemoglobin. Ferritin may help identify iron
deficiency.
11. Women with a history of bariatric surgery may have:
A. Guaranteed normal iron levels
B. No nutritional concerns
C. Excess iron
D. Iron deficiency anemia that should be addressed before birth
Correct Answer: D. Iron deficiency anemia that should be addressed before birth
Rationale: Malabsorption after bariatric surgery commonly causes iron and other deficiencies, which can
reduce tolerance of blood loss. IV iron may be needed. Nutritional monitoring is recommended.
12. Hemorrhage risk assessment, as recommended by the AIM and CMQCC bundles, should be
performed:
A. Only after hemorrhage begins
B. On admission to labor and delivery, and repeated as risk changes during labor and before birth
C. Only at the first prenatal visit
D. Only for cesarean births
Correct Answer: B. On admission to labor and delivery, and repeated as risk changes during
labor and before birth
Rationale: Risk assessment at multiple points allows preparation such as type and screen or crossmatch
and ensures resources are ready. Risk can change during labor, for example with prolonged oxytocin or
chorioamnionitis. Waiting until bleeding begins wastes time.
