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Postpartum haemorrhage — MCCQE Part 1 MCQ

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EasyPostpartumPostpartum haemorrhageMCCQE Part 1

34-year-old woman shortly after vaginal delivery presents with heavy bleeding. The uterus is boggy and estimated blood loss is 900 mL. Which of the following is the most appropriate next step?

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Correct answer: A — Perform uterine massage, give oxytocin and escalate PPH protocol

Perform uterine massage, give oxytocin and escalate PPH protocol is best because boggy uterus indicates uterine atony, the commonest PPH cause. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. PPH management is simultaneous resuscitation, uterotonics and cause identification.

Reference: SOGC postpartum haemorrhage guideline