POSTPARTUM HEMORRHAGE FINAL PAPER 2025/2026
QUESTIONS WITH ANSWERS GRADED A+
✔✔What is a risk of AMTSL, specifically controlled cord traction (CCT)? - ✔✔Cord
avulsion which occurs 3% of the time with CCT.
✔✔True or false. Cord avulsion is an emergency and requires that the placenta be
manually removed immediately. - ✔✔False. Cord avulsion is NOT an emergency
UNLESS it occurs in the context of acute PPH or signs of shock are present.
✔✔What are the signs and symptoms of hypovolemic shock? - ✔✔Hypotension
Oligouria
Change in mental status
Cool and clammy skin
Dry mucus membranes
Metabolic acidosis
✔✔If the uterus is contracted, the placenta is delivered and complete, what is the
probable diagnosis of the source of the PPH? Which "T" is it? - ✔✔Laceration of the
vagina, perineum or cervix (Trauma)
✔✔If the uterine fundus isn't palpable, and the client is reporting intense pain, what is a
probable diagnosis? - ✔✔Inverted uterus (Trauma)
✔✔The client is demonstrating S&S of shock, she's reporting severe abdominal pain but
you do not observe any blood loss. What is the probably diagnosis? - ✔✔Uterine
rupture (Trauma)
✔✔If the client asks for something to drink in a hemorrhage situation, can they eat or
drink? - ✔✔No. They may require surgery and must have nothing p.o.
✔✔What is the first-line treatment for the management of uterine atony? - ✔✔Massage
the uterus and administer uterotonics (i.e. Oxytocin).
✔✔What are the initial steps for the acute hemorrhage management? - ✔✔1. Inform
everyone of the situation
2. Nothing PO
3. Move client to a recumbent (lying down) position
4. Place a wedge under right hip (to prevent vena cava compression)
5. Assess the uterus
✔✔What are second- or third-line uterotonic drugs in the midwifery pharmacopeia? -
✔✔Ergonovine maleate
Carboprost tromethamine (Hemabate)
, Misoprostol
Carbetocin (last resort)
✔✔Does the management of PPH depend on whether or not the placenta is in or out? -
✔✔Yes. If the placenta is still in, avoid giving ergonovine maleate as it has been
"weakly" associated with partially retaining or trapping the placenta. Get the placenta
out.
✔✔Oxytocin for PPH can be given as 10 IU (IM) or 5-10 IU (IV over 1 minute) and
repeated.
What is the dose and route that might be given following this bolus dose? - ✔✔20-40 IU
in 1000 mL (in a bag) crystalloid initially wide open and then titrated as per response
(i.e. 250 mL/hour)
✔✔What are the main cautions/comments for the uterotonic drugs? - ✔✔1. Oxytocin - if
given rapidly via IV, hypotension may occur
2. Ergonovine - contraindicated in hypertensive clients, may "trap" the placenta and can
cause dizziness or vomiting.
3. Carboprost tromethamine - has bronchoconstrictive & vasoconstrictive and GI effects.
Use with caution in clients with asthma.
4. Misoprostol - most common side effects are pyrexia, chills and GI disturbances.
✔✔What are the routes the uterotonic drugs can be given? - ✔✔Oxytocin: IM, IV
Ergonovine maleate: IM, IV
Carboprost tromethamine (hemabate): IM and intramyometrial (IMM)
Misoprostol: orally (PO), sublingual (SL), and per rectum (PR)
✔✔True or false. The dose of Carboprost tromethamine is 200 ug - 400 ug PO or SL
and 400-800 ug PR. - ✔✔False. Carboprost tromethamine is:
0.25 mg IM or IV (in 5mL of NS over 1 minute)
q 2 hrs
✔✔True or false. If the client is unstable and bleeding continues despite delivery of the
placenta and no physician is immediately available, midwives must continue to following
resuscitation measure and wait for the doctor. - ✔✔False. Midwives can manually
explore the uterus and remove any remaining tissue.
QUESTIONS WITH ANSWERS GRADED A+
✔✔What is a risk of AMTSL, specifically controlled cord traction (CCT)? - ✔✔Cord
avulsion which occurs 3% of the time with CCT.
✔✔True or false. Cord avulsion is an emergency and requires that the placenta be
manually removed immediately. - ✔✔False. Cord avulsion is NOT an emergency
UNLESS it occurs in the context of acute PPH or signs of shock are present.
✔✔What are the signs and symptoms of hypovolemic shock? - ✔✔Hypotension
Oligouria
Change in mental status
Cool and clammy skin
Dry mucus membranes
Metabolic acidosis
✔✔If the uterus is contracted, the placenta is delivered and complete, what is the
probable diagnosis of the source of the PPH? Which "T" is it? - ✔✔Laceration of the
vagina, perineum or cervix (Trauma)
✔✔If the uterine fundus isn't palpable, and the client is reporting intense pain, what is a
probable diagnosis? - ✔✔Inverted uterus (Trauma)
✔✔The client is demonstrating S&S of shock, she's reporting severe abdominal pain but
you do not observe any blood loss. What is the probably diagnosis? - ✔✔Uterine
rupture (Trauma)
✔✔If the client asks for something to drink in a hemorrhage situation, can they eat or
drink? - ✔✔No. They may require surgery and must have nothing p.o.
✔✔What is the first-line treatment for the management of uterine atony? - ✔✔Massage
the uterus and administer uterotonics (i.e. Oxytocin).
✔✔What are the initial steps for the acute hemorrhage management? - ✔✔1. Inform
everyone of the situation
2. Nothing PO
3. Move client to a recumbent (lying down) position
4. Place a wedge under right hip (to prevent vena cava compression)
5. Assess the uterus
✔✔What are second- or third-line uterotonic drugs in the midwifery pharmacopeia? -
✔✔Ergonovine maleate
Carboprost tromethamine (Hemabate)
, Misoprostol
Carbetocin (last resort)
✔✔Does the management of PPH depend on whether or not the placenta is in or out? -
✔✔Yes. If the placenta is still in, avoid giving ergonovine maleate as it has been
"weakly" associated with partially retaining or trapping the placenta. Get the placenta
out.
✔✔Oxytocin for PPH can be given as 10 IU (IM) or 5-10 IU (IV over 1 minute) and
repeated.
What is the dose and route that might be given following this bolus dose? - ✔✔20-40 IU
in 1000 mL (in a bag) crystalloid initially wide open and then titrated as per response
(i.e. 250 mL/hour)
✔✔What are the main cautions/comments for the uterotonic drugs? - ✔✔1. Oxytocin - if
given rapidly via IV, hypotension may occur
2. Ergonovine - contraindicated in hypertensive clients, may "trap" the placenta and can
cause dizziness or vomiting.
3. Carboprost tromethamine - has bronchoconstrictive & vasoconstrictive and GI effects.
Use with caution in clients with asthma.
4. Misoprostol - most common side effects are pyrexia, chills and GI disturbances.
✔✔What are the routes the uterotonic drugs can be given? - ✔✔Oxytocin: IM, IV
Ergonovine maleate: IM, IV
Carboprost tromethamine (hemabate): IM and intramyometrial (IMM)
Misoprostol: orally (PO), sublingual (SL), and per rectum (PR)
✔✔True or false. The dose of Carboprost tromethamine is 200 ug - 400 ug PO or SL
and 400-800 ug PR. - ✔✔False. Carboprost tromethamine is:
0.25 mg IM or IV (in 5mL of NS over 1 minute)
q 2 hrs
✔✔True or false. If the client is unstable and bleeding continues despite delivery of the
placenta and no physician is immediately available, midwives must continue to following
resuscitation measure and wait for the doctor. - ✔✔False. Midwives can manually
explore the uterus and remove any remaining tissue.
