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Quizzes > Health & Medicine > Diseases & Conditions

How Well Do You Know Postpartum Hemorrhage? Take the MCQ Quiz!

Ready for a quick postpartum hemorrhage test? Start the MCQ now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration of uterus medical icons and question mark on coral background for postpartum hemorrhage quiz

Ready to elevate your maternal health know-how? Dive into our free postpartum hemorrhage quiz and test your clinical skills! Suitable for students, midwives and practitioners, it features a blend of postpartum hemorrhage MCQ, scenario-based postpartum hemorrhage questions and a timed postpartum hemorrhage test, so you'll uncover key insights into causes, risk factors and proven treatments. Perfect for exam prep or clinical rotations, this PPH quiz online sharpens your decision-making in real-world PPH scenarios. Want more practice? Explore our midwifery questions or try a postpartum depression quiz . Click "Start Quiz" now and master PPH management!

How is primary postpartum hemorrhage defined?
Blood loss ?500 mL after 48 hours postpartum
Blood loss ?500 mL within 24 hours of vaginal delivery
Blood loss ?1000 mL within 48 hours of cesarean delivery
Blood loss ?1000 mL within 24 hours of vaginal delivery
Primary postpartum hemorrhage is clinically defined as blood loss of 500 mL or more after vaginal birth or 1000 mL after cesarean section, occurring within the first 24 hours. This threshold prompts rapid assessment and management to prevent morbidity. Quantification may be visual or using calibrated tools to avoid underestimation. ACOG Committee Opinion on PPH
Which time frame defines secondary postpartum hemorrhage?
Within 24 hours postpartum
Immediately after placental delivery
After 12 weeks postpartum
Between 24 hours and 12 weeks postpartum
Secondary PPH refers to abnormal or excessive bleeding from 24 hours after delivery until 12 weeks postpartum. Common causes include retained products of conception and subinvolution of the uterus. Timely evaluation with ultrasound and clinical exam helps identify etiology. Secondary PPH review
What is the most common cause of postpartum hemorrhage?
Uterine atony
Retained placenta
Coagulopathy
Genital tract lacerations
Uterine atony, failure of the uterus to contract effectively after delivery, accounts for up to 80% of PPH cases. Contraction is essential to compress uterine vessels at the placental bed. Uterotonic agents and uterine massage are first-line interventions. WHO PPH Guidelines
Which mnemonic represents the four major causes of postpartum hemorrhage?
Time, Tenacity, Tension, Thrombosis
Tone, Tissue, Trauma, Thrombin
Temperature, Tone, Trauma, Toxins
Trauma, Toxemia, Tone, Thrombocytopenia
The '4 Ts' mnemonic (Tone, Tissue, Trauma, Thrombin) helps clinicians quickly recall PPH etiologies: uterine atony, retained products, genital tract injury, and coagulopathy. Systematic assessment prevents missed diagnoses. This approach guides targeted management interventions. RCOG PPH Guidelines
What is the first-line uterotonic agent for preventing and treating uterine atony?
Oxytocin
Carboprost tromethamine
Methylergometrine
Misoprostol
Oxytocin is the recommended first-line uterotonic due to its efficacy and safety profile. It promotes uterine contraction by acting on oxytocin receptors in the myometrium. Alternatives are reserved for refractory cases or contraindications. ACOG on Active Management
Which of the following is a recognized risk factor for postpartum hemorrhage?
Nulliparity with no other factors
Advanced maternal age only
Multiple gestation
Short second stage of labor
Multiple gestation increases uterine distension and predisposes to atony postpartum. Other factors include polyhydramnios, high parity, prolonged labor, and chorioamnionitis. Recognizing these risks allows for preparatory management. CDC on Obstetric Hemorrhage
What is the recommended initial management step for uterine atony?
IV antibiotics
Transfusion of packed RBCs
Uterine fundal massage
Immediate hysterectomy
Uterine fundal massage stimulates myometrial contraction and is the first intervention for atony. It is noninvasive, rapid, and can significantly reduce bleeding. If ineffective, uterotonics and escalation follow. JJOG Fundal Massage Study
Which method provides the most accurate estimation of blood loss during delivery?
Visual estimation
Patient-reported soaking
Counting number of pads
Weighing blood-soaked materials
Gravimetric measurement (weighing sponges and drapes) offers greater accuracy in quantifying blood loss than visual estimation, which often underestimates hemorrhage. Each gram corresponds to approximately 1 mL of blood. Accurate measurement is critical for timely intervention. Gravimetric vs Visual Estimation
Within what time frame should tranexamic acid be administered for postpartum hemorrhage?
Only after failure of uterine massage
Any time during hospitalization
Within 3 hours of bleeding onset
After 12 hours if bleeding persists
Tranexamic acid reduces mortality from PPH when given within 3 hours of onset, inhibiting fibrinolysis. Delayed administration is less effective. Recommended dose is 1 g IV over 10 minutes. WHO on Tranexamic Acid
Active management of the third stage of labor includes all EXCEPT:
Uterine massage after delivery
Immediate cord clamping
Controlled cord traction
Uterotonic administration
Immediate cord clamping is not recommended; delayed clamping of 1 - 3 minutes improves neonatal outcomes. Active management comprises prophylactic uterotonics, controlled cord traction, and uterine massage. These steps reduce the incidence of PPH. WHO Active Management
When is uterine balloon tamponade indicated in PPH management?
As the initial treatment before any uterotonics
Only in cases of trauma-induced hemorrhage
After failure of first-line uterotonics and massage
Only for coagulopathic patients
Balloon tamponade is a second-line mechanical intervention when uterotonics and uterine massage do not control bleeding. It applies direct pressure to the uterine walls to tamponade bleeding vessels. Early use can prevent surgical procedures. Balloon Tamponade Review
Which misoprostol dose is recommended for PPH treatment when IV uterotonics are unavailable?
1000 µg vaginal
400 µg rectal once
200 µg oral
800 µg sublingual
Sublingual misoprostol 800 µg is recommended by WHO for PPH treatment when injectable uterotonics are not available. It has rapid absorption and good uterotonic effect. Rectal or oral routes are less effective. WHO PPH Guidelines
Which imaging modality aids in diagnosing retained placental tissue in secondary PPH?
CT scan of the pelvis
Transvaginal ultrasound
Abdominal X-ray
MRI of the abdomen
Transvaginal ultrasound is the first-line imaging to detect retained products of conception in secondary PPH. It provides high-resolution views of the endometrial cavity. Management may include surgical evacuation based on findings. Ultrasound in Secondary PPH
What is the immediate management for severe bleeding from uterine atony and hemodynamic instability?
Administration of broad-spectrum antibiotics
Observation only
Uterine artery embolization immediately
Bimanual uterine compression
Bimanual uterine compression is a rapid, bedside maneuver to compress uterine walls and control hemorrhage in atony with shock. It temporizes bleeding while preparing additional interventions. Antibiotics and embolization are later or adjunctive therapies. EMJ Review on PPH
Which retained tissue is most likely to cause postpartum hemorrhage under the 'Tissue' category?
Endometrial hyperplasia
Ovarian cysts
Retained placental fragments
Uterine fibroids
Retained placental fragments prevent complete uterine contraction and continue bleeding from the placental bed. This is classified under the 'Tissue' cause in the 4 Ts. Diagnosis often requires ultrasound and may need evacuation. Placental Retention Overview
When should recombinant factor VIIa be considered in PPH management?
After failure of uterotonics, uterine compression, and when coagulopathy persists
As first-line therapy for atony
Only in absence of coagulopathy
For all secondary PPH cases
Recombinant factor VIIa is an off-label adjunct for refractory PPH with ongoing bleeding and confirmed coagulopathy. It enhances thrombin generation. Use is reserved due to thrombosis risk. UpToDate on rFVIIa
What surgical procedure involves ligation of vessels to control severe PPH while preserving fertility?
Bilateral tubal ligation
Hysterectomy
Oophorectomy
Internal iliac artery ligation
Internal iliac (hypogastric) artery ligation reduces pelvic blood flow by decreasing pulse pressure, controlling intractable hemorrhage and preserving the uterus. Mastery of pelvic anatomy is critical. Hysterectomy is definitive but sacrifices fertility. IIA Ligation in PPH
What shock index (heart rate divided by systolic blood pressure) suggests significant PPH requiring urgent intervention?
Exactly 0.7
Less than 0.3
Less than 0.5
Greater than 0.9
Shock index >0.9 has been correlated with significant blood loss and impending hemodynamic instability in obstetrics. It is a quick bedside metric that outperforms vital signs alone. Early recognition triggers massive transfusion protocols. Shock Index in Obstetrics
Which device is specifically designed for uterine tamponade in PPH?
Bakri balloon
Foley catheter
Cervical dilator
Intrauterine insemination catheter
The Bakri balloon is a specialized intrauterine tamponade device with a drainage lumen, designed to control PPH by applying pressure against the uterine wall. It can be filled up to 500 mL. Success rates exceed 80% in refractory atony. Bakri Balloon Study
Which condition is a contraindication to the use of methylergometrine for PPH?
Hypertension
Diabetes mellitus
Asthma
Hypothyroidism
Methylergometrine is contraindicated in hypertension because it can cause severe vasospasm and increase blood pressure dangerously. It is also avoided in preeclampsia. Alternatives like oxytocin or prostaglandins are preferred in hypertensive patients. UpToDate on Methylergometrine
What is the recommended IV dose of tranexamic acid for PPH?
2 g bolus
500 mg over 1 hour
100 mg slow push
1 g over 10 minutes
The WOMAN trial supports administering 1 g of tranexamic acid intravenously over 10 minutes, which reduces death due to bleeding if given within 3 hours. A second dose may be given if bleeding continues. Rapid administration maximizes benefit. WOMAN Trial
What is the optimal ratio of packed red blood cells to fresh frozen plasma in a massive transfusion protocol for PPH?
2:1
1:1
1:2
4:1
A balanced 1:1 ratio of red blood cells to fresh frozen plasma in massive transfusion protocols improves hemostatic resuscitation and reduces coagulopathy. This approach has been extrapolated from trauma literature to obstetric hemorrhage. Early activation is critical. ACOG on Massive Transfusion
In cases of placenta accreta spectrum with life-threatening hemorrhage, what is the definitive management?
High-dose uterotonics only
Planned cesarean hysterectomy
Uterine artery embolization alone
Conservative placenta left in situ
Placenta accreta spectrum often requires planned cesarean hysterectomy without attempting placental removal to prevent catastrophic hemorrhage. This definitive approach is prearranged with multidisciplinary teams. Conservative measures have high morbidity in severe cases. Placenta Accreta Management
Which anesthetic modality allows rapid detection of hemodynamic changes during PPH?
Invasive arterial blood pressure monitoring
Continuous ECG monitoring only
Pulse oximetry alone
Standard noninvasive cuff every 15 minutes
Invasive arterial monitoring provides beat-to-beat blood pressure readings, enabling early detection of hypotension and rapid titration of fluids and vasopressors. It is recommended for anticipated massive PPH. Noninvasive methods lag and may miss acute shifts. WFSA on Obstetric Hemorrhage
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Study Outcomes

  1. Identify primary causes of postpartum hemorrhage -

    By completing the quiz, you will be able to recognize and categorize the main etiologies of PPH, including uterine atony, retained placenta, genital tract trauma, and coagulopathies.

  2. Analyze risk factors associated with PPH -

    Learn to evaluate patient history and clinical indicators such as prolonged labor, multiple gestations, and previous bleeding disorders to assess hemorrhage risk.

  3. Apply diagnostic criteria and clinical signs -

    Gain proficiency in measuring blood loss estimates, monitoring vital signs, and identifying early warning signs to promptly diagnose postpartum hemorrhage.

  4. Compare management strategies -

    Understand the stepwise treatment approach, from uterotonic agents and uterine massage to surgical interventions, to tailor therapy effectively.

  5. Evaluate preventive measures and protocols -

    Assess current guidelines and best practices for PPH prevention, including active management of the third stage of labor and prophylactic uterotonics.

  6. Reinforce knowledge through scenario-based questions -

    Use case studies in the quiz to test decision-making skills and solidify your understanding of postpartum hemorrhage management.

Cheat Sheet

  1. Definition & Classification -

    Postpartum hemorrhage is defined as blood loss ≥500 mL after vaginal birth or ≥1000 mL after cesarean delivery within 24 hours, based on WHO criteria. It's further classified into primary (within 24 h) and secondary (24 h to 12 weeks), helping you frame timely interventions. Remembering these thresholds ensures you recognize PPH quickly in any postpartum hemorrhage quiz scenario.

  2. Four T's Mnemonic for Causes -

    Use the FOUR T's mnemonic - Tone, Tissue, Trauma, Thrombin - to recall the major causes of PPH. For example, uterine atony (Tone) accounts for up to 70% of cases (ISHGS guidelines).

  3. Key Risk Factors -

    Antepartum risk factors include placenta previa, high parity, and multiple gestations, while intrapartum factors like prolonged labor or oxytocin overuse further increase risk. A handy trick is to list "3 Ps": Placenta, Parity, Polyhydramnios to memorize common contributors.

  4. First-Line Management Steps -

    Initial management combines uterine massage with uterotonics like 10 IU IV oxytocin as per ACOG. If bleeding persists, consider balloon tamponade (e.g., Bakri balloon) or surgical options, following WHO's stepwise approach. Confidently applying these steps can boost your score on a PPH quiz online.

  5. Assessment & Monitoring Tools -

    Quantify blood loss precisely using calibrated drapes (1 g pad weight = 1 mL blood) and calculate the Shock Index (heart rate/systolic BP) - a value >0.9 signals severe hemorrhage. Lab monitoring of hemoglobin drop ≥10% within 24 hours also guides transfusion decisions. Keeping track of these numbers helps you master any postpartum hemorrhage MCQ.

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