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Postpartum haemorrhage drug — DipIMC MCQ

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HardPaediatric and Obstetric EmergenciesPostpartum haemorrhage drugDipIMC

Immediately after an uncomplicated home birth, a woman has brisk vaginal bleeding; the placenta is complete and the uterus is boggy. A trained clinician is present and obstetric transfer is underway. Which initial management bundle is most appropriate?

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Correct answer: E — Begin uterine massage, haemorrhage resuscitation and protocolled uterotonic treatment

The best answer is “Begin uterine massage, haemorrhage resuscitation and protocolled uterotonic treatment”. A boggy uterus after placental delivery suggests atonic postpartum haemorrhage. Immediate management combines uterine massage, structured haemorrhage resuscitation, uterotonic treatment within scope and urgent obstetric escalation. Tranexamic acid may be an important adjunct but cannot be the sole response. Manual uterine exploration requires appropriate setting, analgesia and obstetric expertise.

Reference: RCOG Green-top Guideline 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/