Postpartum Hemorrhage: Exam 3 - Questions with Correct
Answers
100 questions
1. Women with postpartum hemorrhage are also at increased risk of:
A. Improved emotional wellbeing
B. Shorter hospital stays
C. Postpartum depression and post-traumatic stress symptoms
D. Better breastfeeding outcomes
Correct Answer: C. Postpartum depression and post-traumatic stress symptoms
Rationale: A frightening birth experience, separation from the baby, anemia and fatigue contribute to
psychological distress. Debriefing and screening are recommended. Hospital stays are often longer, and
breastfeeding may be harder.
2. Postpartum hemorrhage can lead to Sheehan syndrome, which is:
A. A type of uterine infection
B. Pituitary necrosis from hypovolemic shock, causing failure to lactate and hormone deficiencies
C. A bleeding disorder
D. A cause of hypertension
Correct Answer: B. Pituitary necrosis from hypovolemic shock, causing failure to lactate and
hormone deficiencies
Rationale: The enlarged pituitary of pregnancy is vulnerable to ischemia; early signs include failure of
lactation and later amenorrhea, fatigue and hypothyroidism. It is a rare complication of severe
hemorrhage. It is not infectious.
3. Postpartum hemorrhage is classified by severity, with severe or massive PPH often defined
as:
A. Any blood loss under 200 mL
B. Blood loss of 300 mL without symptoms
C. Blood loss greater than 1,500 to 2,000 mL or requiring transfusion of multiple units
D. Spotting on day 10
Correct Answer: C. Blood loss greater than 1,500 to 2,000 mL or requiring transfusion of
multiple units
Rationale: Definitions vary, but massive PPH involves large volume loss, rapid loss or need for massive
transfusion, and requires full escalation of care. Small losses without symptoms are not severe PPH. Light
spotting is normal lochia.
,4. Concealed hemorrhage after birth may occur with:
A. Vulvar, vaginal, or retroperitoneal hematomas and intra-abdominal bleeding
B. Only visible vaginal bleeding
C. Increased urine output
D. Normal vital signs at all times
Correct Answer: A. Vulvar, vaginal, or retroperitoneal hematomas and intra-abdominal
bleeding
Rationale: Blood can accumulate in tissues or cavities without appearing externally, so unexplained pain,
pressure or instability should prompt careful examination and imaging. Vital signs eventually change.
Visible bleeding alone can underestimate total loss.
5. Average blood loss at an uncomplicated vaginal birth is typically:
A. About 2,000 mL
B. About 1,500 mL
C. Less than 500 mL
D. None
Correct Answer: C. Less than 500 mL
Rationale: Most uncomplicated vaginal births involve losses well under 500 mL, which healthy women
tolerate due to pregnancy adaptations. Some bleeding always occurs. Much larger losses indicate
hemorrhage.
6. The third stage of labor refers to:
A. The period of cervical dilation
B. The period from birth of the baby to delivery of the placenta
C. The period of pushing
D. The 6 weeks after birth
Correct Answer: B. The period from birth of the baby to delivery of the placenta
Rationale: The third stage is when PPH prevention measures such as uterotonic administration are
applied. The first stage involves dilation and the second stage pushing. The postpartum period follows.
,7. Hemorrhage is the leading cause of maternal death in the first 24 hours after birth because:
A. Infection peaks on day 1
B. Most PPH occurs in this period, when uterine atony and trauma bleeding are greatest
C. Thromboembolism peaks in the first hour
D. Cardiomyopathy only occurs on day 1
Correct Answer: B. Most PPH occurs in this period, when uterine atony and trauma bleeding
are greatest
Rationale: The first hours, especially the first hour after placental delivery, carry the greatest bleeding
risk, so close monitoring of fundus, bleeding and vital signs is required. Infection, thromboembolism and
cardiomyopathy typically cause deaths later.
8. Late in pregnancy, the number of oxytocin receptors in the myometrium:
A. Decreases to zero
B. Remains unchanged
C. Increases markedly, enhancing sensitivity to oxytocin
D. Is irrelevant to labor
Correct Answer: C. Increases markedly, enhancing sensitivity to oxytocin
Rationale: Receptor upregulation prepares the uterus for labor and postpartum contraction. Prolonged
oxytocin exposure during labor can desensitize receptors, reducing effectiveness postpartum. They are
essential for labor.
9. For women with high hemorrhage risk, crossmatching 2 to 4 units of red blood cells before
delivery:
A. Ensures blood is immediately available if hemorrhage occurs
B. Is unnecessary in all cases
C. Replaces uterotonics
D. Causes transfusion reactions automatically
Correct Answer: A. Ensures blood is immediately available if hemorrhage occurs
Rationale: Having crossmatched blood ready reduces delays in transfusion, a common contributor to
poor outcomes. It does not replace other measures. Crossmatching itself does not cause reactions.
, 10. Grand multiparity (five or more prior births) has traditionally been associated with:
A. Decreased risk of atony
B. Increased risk of uterine atony
C. No relationship to bleeding
D. Only increased risk of preterm birth
Correct Answer: B. Increased risk of uterine atony
Rationale: Repeated stretching of the myometrium may reduce contractility, although modern data are
mixed. It remains a factor in many risk assessment tools. It is not protective.
11. Obesity is associated with increased PPH risk partly due to:
A. Faster labors
B. Lower cesarean rates
C. Higher rates of induction, prolonged labor, cesarean birth, and macrosomia
D. Reduced uterine size
Correct Answer: C. Higher rates of induction, prolonged labor, cesarean birth, and
macrosomia
Rationale: These associations increase the chance of atony and surgical bleeding, and assessment of
blood loss can also be more difficult. Obesity does not shorten labor or reduce cesarean rates.
12. Antepartum hemorrhage in the current pregnancy, such as from previa or abruption, is
associated with:
A. Protection against PPH
B. No effect on postpartum bleeding
C. Lower transfusion rates
D. Increased risk of postpartum hemorrhage
Correct Answer: D. Increased risk of postpartum hemorrhage
Rationale: Conditions that cause bleeding before birth often continue to cause bleeding afterward
through placental site problems or coagulopathy. Women may also already be anemic. These patients
need preparation.
Answers
100 questions
1. Women with postpartum hemorrhage are also at increased risk of:
A. Improved emotional wellbeing
B. Shorter hospital stays
C. Postpartum depression and post-traumatic stress symptoms
D. Better breastfeeding outcomes
Correct Answer: C. Postpartum depression and post-traumatic stress symptoms
Rationale: A frightening birth experience, separation from the baby, anemia and fatigue contribute to
psychological distress. Debriefing and screening are recommended. Hospital stays are often longer, and
breastfeeding may be harder.
2. Postpartum hemorrhage can lead to Sheehan syndrome, which is:
A. A type of uterine infection
B. Pituitary necrosis from hypovolemic shock, causing failure to lactate and hormone deficiencies
C. A bleeding disorder
D. A cause of hypertension
Correct Answer: B. Pituitary necrosis from hypovolemic shock, causing failure to lactate and
hormone deficiencies
Rationale: The enlarged pituitary of pregnancy is vulnerable to ischemia; early signs include failure of
lactation and later amenorrhea, fatigue and hypothyroidism. It is a rare complication of severe
hemorrhage. It is not infectious.
3. Postpartum hemorrhage is classified by severity, with severe or massive PPH often defined
as:
A. Any blood loss under 200 mL
B. Blood loss of 300 mL without symptoms
C. Blood loss greater than 1,500 to 2,000 mL or requiring transfusion of multiple units
D. Spotting on day 10
Correct Answer: C. Blood loss greater than 1,500 to 2,000 mL or requiring transfusion of
multiple units
Rationale: Definitions vary, but massive PPH involves large volume loss, rapid loss or need for massive
transfusion, and requires full escalation of care. Small losses without symptoms are not severe PPH. Light
spotting is normal lochia.
,4. Concealed hemorrhage after birth may occur with:
A. Vulvar, vaginal, or retroperitoneal hematomas and intra-abdominal bleeding
B. Only visible vaginal bleeding
C. Increased urine output
D. Normal vital signs at all times
Correct Answer: A. Vulvar, vaginal, or retroperitoneal hematomas and intra-abdominal
bleeding
Rationale: Blood can accumulate in tissues or cavities without appearing externally, so unexplained pain,
pressure or instability should prompt careful examination and imaging. Vital signs eventually change.
Visible bleeding alone can underestimate total loss.
5. Average blood loss at an uncomplicated vaginal birth is typically:
A. About 2,000 mL
B. About 1,500 mL
C. Less than 500 mL
D. None
Correct Answer: C. Less than 500 mL
Rationale: Most uncomplicated vaginal births involve losses well under 500 mL, which healthy women
tolerate due to pregnancy adaptations. Some bleeding always occurs. Much larger losses indicate
hemorrhage.
6. The third stage of labor refers to:
A. The period of cervical dilation
B. The period from birth of the baby to delivery of the placenta
C. The period of pushing
D. The 6 weeks after birth
Correct Answer: B. The period from birth of the baby to delivery of the placenta
Rationale: The third stage is when PPH prevention measures such as uterotonic administration are
applied. The first stage involves dilation and the second stage pushing. The postpartum period follows.
,7. Hemorrhage is the leading cause of maternal death in the first 24 hours after birth because:
A. Infection peaks on day 1
B. Most PPH occurs in this period, when uterine atony and trauma bleeding are greatest
C. Thromboembolism peaks in the first hour
D. Cardiomyopathy only occurs on day 1
Correct Answer: B. Most PPH occurs in this period, when uterine atony and trauma bleeding
are greatest
Rationale: The first hours, especially the first hour after placental delivery, carry the greatest bleeding
risk, so close monitoring of fundus, bleeding and vital signs is required. Infection, thromboembolism and
cardiomyopathy typically cause deaths later.
8. Late in pregnancy, the number of oxytocin receptors in the myometrium:
A. Decreases to zero
B. Remains unchanged
C. Increases markedly, enhancing sensitivity to oxytocin
D. Is irrelevant to labor
Correct Answer: C. Increases markedly, enhancing sensitivity to oxytocin
Rationale: Receptor upregulation prepares the uterus for labor and postpartum contraction. Prolonged
oxytocin exposure during labor can desensitize receptors, reducing effectiveness postpartum. They are
essential for labor.
9. For women with high hemorrhage risk, crossmatching 2 to 4 units of red blood cells before
delivery:
A. Ensures blood is immediately available if hemorrhage occurs
B. Is unnecessary in all cases
C. Replaces uterotonics
D. Causes transfusion reactions automatically
Correct Answer: A. Ensures blood is immediately available if hemorrhage occurs
Rationale: Having crossmatched blood ready reduces delays in transfusion, a common contributor to
poor outcomes. It does not replace other measures. Crossmatching itself does not cause reactions.
, 10. Grand multiparity (five or more prior births) has traditionally been associated with:
A. Decreased risk of atony
B. Increased risk of uterine atony
C. No relationship to bleeding
D. Only increased risk of preterm birth
Correct Answer: B. Increased risk of uterine atony
Rationale: Repeated stretching of the myometrium may reduce contractility, although modern data are
mixed. It remains a factor in many risk assessment tools. It is not protective.
11. Obesity is associated with increased PPH risk partly due to:
A. Faster labors
B. Lower cesarean rates
C. Higher rates of induction, prolonged labor, cesarean birth, and macrosomia
D. Reduced uterine size
Correct Answer: C. Higher rates of induction, prolonged labor, cesarean birth, and
macrosomia
Rationale: These associations increase the chance of atony and surgical bleeding, and assessment of
blood loss can also be more difficult. Obesity does not shorten labor or reduce cesarean rates.
12. Antepartum hemorrhage in the current pregnancy, such as from previa or abruption, is
associated with:
A. Protection against PPH
B. No effect on postpartum bleeding
C. Lower transfusion rates
D. Increased risk of postpartum hemorrhage
Correct Answer: D. Increased risk of postpartum hemorrhage
Rationale: Conditions that cause bleeding before birth often continue to cause bleeding afterward
through placental site problems or coagulopathy. Women may also already be anemic. These patients
need preparation.
