Test Bank Questions and Answers for Postpartum Hemorrhage Already Passed
Postpartum hemorrhage - Answers is excessive maternal bleeding after delivery of an infant and has
multiple causes. Postpartum hemorrhage is classified into two groups: early postpartum hemorrhage
and late postpartum hemorrhage. The most common cause of early postpartum hemorrhage is uterine
atony, but it can also be caused by trauma, lacerations, and hematomas. Late postpartum hemorrhage is
most commonly caused by retained placental fragments.
Timing of early postpartum hemorrhage - Answers Occurs in the first 24 hours after childbirth
Timing of late postpartum hemorrhage - Answers Occurs after 24 hours for up to 12 weeks after
childbirth
causes of early postpartum hemorrhage - Answers Uterine atony
Trauma to the birth canal during labor and birth caused by lacerations, episiotomies, or uterine rupture
Hematomas (localized collections of blood in a space or tissue)
Retention of placental or amniotic fragments
Abnormalities of coagulation
Causes of late postpartum hemorrhage - Answers Subinvolution (delayed return of the uterus to its
nonpregnant size and consistency)
Retained placental or amniotic fragments
Infection of the uterus
Uterine Atony - Answers This is the most common cause of early postpartum hemorrhage. Relaxed
uterine muscles allow rapid bleeding from endometrial arteries.
This is characterized by a fundus that feels "boggy" (soft, flaccid) or is difficult to locate.
Risk Factors for uterine atony - Answers Contractions that were minimally effective, resulting in
prolonged labor
Contractions that were excessively vigorous, resulting in precipitate labor
Placental abruption: early detachment of the placenta from the uterus
Placenta previa: the placenta covers or is near the cervical opening
Overdistended uterus: excessive enlargement of the uterus due to too much amniotic fluid
(polyhydramnios) or a large infant (macrosomia), especially with birthweight of more than 4000 grams
(8.8 pounds)
, Multifetal gestation
Pregnancy-induced hypertension (PIH)
Multiparity
Prolonged labor
Maternal infection
Endometriosis
Maternal obesity
Induction or augmentation of labor with oxytocin
Tocolytic medications to stop contractions (for preterm labor)
General anesthesia
Vacuum extractor—or forceps-assisted delivery
History of postpartum hemorrhage
Best practice dictates that all women be screened throughout their hospital stay for their risk for
postpartum hemorrhage. This risk may increase due to - Answers events in labor and delivery. When a
high hemorrhage risk is identified, the interdisciplinary team should work together with the blood bank
to ensure there is an adequate blood supply on-hand. A Type & Cross and CBC should be obtained.
Soft tissue trauma (lacerations, hematomas) can cause - Answers rapid loss of blood even when the
uterus is firmly contracted.
Vaginal, Cervical, and Perineal Lacerations - Answers Risk factors include delivery of a large infant,
induction or augmentation of labor with oxytocin, or use of forceps or vacuum extractor.
A large amount of vaginal bleeding may be noted, but the fundus may be firm on palpation.
Hematomas - Answers Risk factors include use of vacuum extractors or forceps during delivery,
traumatic delivery, or large infant. Bleeding is not visible, but the woman will exhibit signs and
symptoms of bleeding, as well as persistent pain in the vagina.
Occur when bleeding into loose connective tissue occurs while overlying tissue remains intact.
May be found in vulvar, vaginal, and retroperitoneal areas. Vaginal and retroperitoneal hematomas are
not visible.
Develop as a result of blood vessel injury.
Postpartum hemorrhage - Answers is excessive maternal bleeding after delivery of an infant and has
multiple causes. Postpartum hemorrhage is classified into two groups: early postpartum hemorrhage
and late postpartum hemorrhage. The most common cause of early postpartum hemorrhage is uterine
atony, but it can also be caused by trauma, lacerations, and hematomas. Late postpartum hemorrhage is
most commonly caused by retained placental fragments.
Timing of early postpartum hemorrhage - Answers Occurs in the first 24 hours after childbirth
Timing of late postpartum hemorrhage - Answers Occurs after 24 hours for up to 12 weeks after
childbirth
causes of early postpartum hemorrhage - Answers Uterine atony
Trauma to the birth canal during labor and birth caused by lacerations, episiotomies, or uterine rupture
Hematomas (localized collections of blood in a space or tissue)
Retention of placental or amniotic fragments
Abnormalities of coagulation
Causes of late postpartum hemorrhage - Answers Subinvolution (delayed return of the uterus to its
nonpregnant size and consistency)
Retained placental or amniotic fragments
Infection of the uterus
Uterine Atony - Answers This is the most common cause of early postpartum hemorrhage. Relaxed
uterine muscles allow rapid bleeding from endometrial arteries.
This is characterized by a fundus that feels "boggy" (soft, flaccid) or is difficult to locate.
Risk Factors for uterine atony - Answers Contractions that were minimally effective, resulting in
prolonged labor
Contractions that were excessively vigorous, resulting in precipitate labor
Placental abruption: early detachment of the placenta from the uterus
Placenta previa: the placenta covers or is near the cervical opening
Overdistended uterus: excessive enlargement of the uterus due to too much amniotic fluid
(polyhydramnios) or a large infant (macrosomia), especially with birthweight of more than 4000 grams
(8.8 pounds)
, Multifetal gestation
Pregnancy-induced hypertension (PIH)
Multiparity
Prolonged labor
Maternal infection
Endometriosis
Maternal obesity
Induction or augmentation of labor with oxytocin
Tocolytic medications to stop contractions (for preterm labor)
General anesthesia
Vacuum extractor—or forceps-assisted delivery
History of postpartum hemorrhage
Best practice dictates that all women be screened throughout their hospital stay for their risk for
postpartum hemorrhage. This risk may increase due to - Answers events in labor and delivery. When a
high hemorrhage risk is identified, the interdisciplinary team should work together with the blood bank
to ensure there is an adequate blood supply on-hand. A Type & Cross and CBC should be obtained.
Soft tissue trauma (lacerations, hematomas) can cause - Answers rapid loss of blood even when the
uterus is firmly contracted.
Vaginal, Cervical, and Perineal Lacerations - Answers Risk factors include delivery of a large infant,
induction or augmentation of labor with oxytocin, or use of forceps or vacuum extractor.
A large amount of vaginal bleeding may be noted, but the fundus may be firm on palpation.
Hematomas - Answers Risk factors include use of vacuum extractors or forceps during delivery,
traumatic delivery, or large infant. Bleeding is not visible, but the woman will exhibit signs and
symptoms of bleeding, as well as persistent pain in the vagina.
Occur when bleeding into loose connective tissue occurs while overlying tissue remains intact.
May be found in vulvar, vaginal, and retroperitoneal areas. Vaginal and retroperitoneal hematomas are
not visible.
Develop as a result of blood vessel injury.
