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PCOS management — USMLE Step 3 MCQ

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HardOB/GYN (Prenatal / Contraception / Screening)PCOS managementUSMLE Step 3

Uterine atony causes ongoing postpartum hemorrhage despite massage and oxytocin. Severe asthma and blood pressure 174/108 mm Hg constrain additional uterotonics. Within 1 hour of birth, which tranexamic-acid regimen should accompany resuscitation and hemorrhage control?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Infuse 1 g over 10 minutes; repeat in 30 minutes for ongoing bleeding

The best answer is “Infuse 1 g over 10 minutes; repeat in 30 minutes for ongoing bleeding”. The recommended early postpartum-hemorrhage regimen is tranexamic acid 1 g intravenously over 10 minutes within 3 hours of birth. A second 1-g dose is given after 30 minutes if bleeding continues or if it restarts within 24 hours. Tranexamic acid complements resuscitation and source control; the asthma and severe hypertension make carboprost and methylergonovine poor alternatives.

Reference: ACOG Practice Bulletin: Postpartum Hemorrhage: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage