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Primary postpartum haemorrhage — DRCOG MCQ

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HardPostnatalPrimary postpartum haemorrhageDRCOG

Two hours after vaginal birth, a 37-year-old has brisk bleeding, pulse 120/min, BP 92/58 mmHg and a boggy enlarged uterus. The placenta appears complete. Which immediate response is best?

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Correct answer: DActivate major-haemorrhage care with resuscitation, uterine massage and uterotonics

The best answer is “Activate major-haemorrhage care with resuscitation, uterine massage and uterotonics”. This is primary postpartum haemorrhage with shock and uterine atony. Emergency help, ABC resuscitation, blood products as indicated, uterine massage and prompt uterotonic treatment occur in parallel, with tranexamic acid and escalation according to response and the four causes. Investigation or definitive surgery must not delay immediate stabilisation and atony treatment.

Reference: RCOG Green-top Guideline No. 52: Prevention and Management of Postpartum Haemorrhage: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/prevention-and-management-of-postpartum-haemorrhage-green-top-guideline-no-52/