1. Primary postpartum haemorrhage – which of the listed options is most likely to be required first? Be definitive.

Possible Answers

For each of the questions below, select the answer which is most appropriate. Each option can be used once, more than once or not at all.

a.) A woman has had a forceps delivery with an episiotomy. She is bleeding heavily from the posterior vaginal wall.

Choose from one of the following answersA Examination under anaestheticB LaparotomyC Drugs to contract the uterusD Increase breastfeeding to stimulate uterine contractionsE Transfusion of cross-matched bloodF Manual removal of placentaG Perineal suturing

b.) A woman with a previous caesarean section has had a difficult forceps delivery with an estimated blood loss of 500 mL. Fifteen minutes later she complains of abdominal pain, feels dizzy and collapses. Her pulse is 120 beats/minute, she is sweaty and poorly perfused. Although her uterus appears well contracted, her abdomen is distended.

Choose from one of the following answersA Examination under anaestheticB LaparotomyC Drugs to contract the uterusD Increase breastfeeding to stimulate uterine contractionsE Transfusion of cross-matched bloodF Manual removal of placentaG Perineal suturing

c.) A woman delivered normally and with an intact perineum 50 minutes previously and is still bleeding vaginally; the total blood loss is now estimated as 1 litre. The third stage is complete, and she has already been given Syntometrine, an oxytocin infusion and misoprostol. Despite this, the uterus appears high.

Choose from one of the following answersA Examination under anaestheticB LaparotomyC Drugs to contract the uterusD Increase breastfeeding to stimulate uterine contractionsE Transfusion of cross-matched bloodF Manual removal of placentaG Perineal suturing

d.) A woman has had a caesarean section 8 hours previously with an estimated blood loss of 750 mL. Her observations are stable but she has a continuous tachycardia, is very pale and cannot stand up. Her uterus is well contracted.

Choose from one of the following answersA Examination under anaestheticB LaparotomyC Drugs to contract the uterusD Increase breastfeeding to stimulate uterine contractionsE Transfusion of cross-matched bloodF Manual removal of placentaG Perineal suturing

e.) A woman has delivered her fourth child and has had a ‘physiological’ third stage, without drugs. Five minutes after delivery, she has a sudden gush of about 500 mL of blood.

Choose from one of the following answersA Examination under anaestheticB LaparotomyC Drugs to contract the uterusD Increase breastfeeding to stimulate uterine contractionsE Transfusion of cross-matched bloodF Manual removal of placentaG Perineal suturing