Postpartum Problems ( Platinum ) – EMQ

Option List:

A. Syntometrine
B. Oxytocin intramuscular
C. Group specific blood transfusion
D. Carboprosti.m 0.25 mg
E. Rh negative blood transfusion
F. Oxytocin intravenous
G. EUA
H. Oxytocin infusion
I. FFP and cryprecipitate
J. HDU care
K. Misoprostol 1000mg sublingually
L. MOEWS chart
M. Involve the consultant

For each of the following scenario, choose the single most appropriate option from the list given above. Each option may be used once or more than once or not at all.

1. 29 year old multiparous delivered male baby weighing 3.6 kg by spontaneous vaginal delivery with a good APGAR. Following delivery placenta and membranes expelled intoto. She had atonic PPH following delivery which was managed with oxytocin. Her pulse is 98/min and her BP is 100/60 mmhg. The best management option is

2. 30 year old multiparous woman delivered vaginally at A&E following a precipitate labour with profuse vaginal bleeding. On examination she was found to have atonic Uterus with a small perineal tear. IV access was secured and immediate resuscitate measures started. The best management is

3. 36 year old woman delivered her first baby by outlet forceps delivery for fetal distress. Following the placental delivery she had profuse vaginal bleeding and on examination was found to have well contracted uterus and the placental membranes were completely removed. Immediate resuscitate measures initiated. The management option is

4. A 24 year old primigravida undergoes induction of labour at 34 weeks of gestation for severe preeclampsia for which she was on magnesium sulphate infusion. Following vaginal delivery she was found to have PPH for which oxytocin injection and infusion was started. Resuscitative measures initiated.Bimanual uterine compression also is being performed. Bleeding persisted and the next management option is

5. Ms.Jaqueline , single woman has schizophrenia experienced her first schizophrenic episode requiring inpatient psychiatric care, 12 months prior to pregnancy. She has been well controlled on haloperidol depot injections since then .She is currently at 36 weeks of gestation and is well. She lives alone and has very limited social support.

6. Mrs. lovely ,32 year old solicitor comes to the antenatal clinic at 20weeks’ gestation. She tells you that following her previous pregnancy, she was she tells u that admitted to the MBU for “a few weeks”.afterdleivery of her first child .She is unsure of what her diagnosis was, and is this time she is adamant that “she does not want to go back there again”. She declines an outpatient appointment with the perinatal team. She says that she currently has no psychiatric symptoms and is not on any medication.
What is the best management plan in this situation?

Option List:
A. Postpartum blue
B. Postpartum Depression
C. Postpartum Psychosis
D. Bipolar disorders
E. Anxiety disorder
F. Schizophrenia
G. Noneof the above
H. Sheehans syndrome
I. Adjustment disorders
Each of the above options describes various clinical diagnosis inPostpartum women presenting with mental health issues. For each patient select the single most appropriate diagnosis option from the list.

7. Mrs.Anora, 24 year, primiparous woman, delivered her first baby 5 days back, is extremely tearful. She has anxiety about whether she can take care of baby well. Husbands says she is crying for small things. She is taking care of baby well .

8. Mrs. Angelina Robert,has come to meet you. She is sister of Mrs.Mayflower,who delivered her first baby, 7 days ago.She is not sleeping well and she is agitated with some odd behaviour .
She is hearing voices in TV and radio that someone is coming to harm her baby.She is in low mood since 24 hrs making it difficult to take care of the baby.She has no specific past history

9. Mrs. Bainy, delivered 7days ago, has intense feeling of hopelessness, worthlessness. She is restless. She is extremely anxious and has panic attacks, sometimes she has thoughts of harming herself or baby. She has recurrent thoughts of death or suicide.

Option List:

A. Do nothing
B. FFP 12-15 ml/mg
C. Platelet transfusion
D. Cryoprecipitate
E. Packed red cell
F. O negative kell negative blood
G. Protamine sulphate
H. Fibrinogen concentrate
I. Recombinant factor VIIA

Each of the above options describes women presenting with postpartum haemorrhage.
For each patient select the single most appropriate management option from the list.

10. Mrs. Anna, 34 year old multiparous, delivered normally, had a major atonic postpartum haemorrhage of 1200 ml. Bleeding stopped with Bakri balloon tamponade, now bleeding settled and she is hemodynamically stable, 4th unit blood ongoing. Her Hb is 75g/L. Platelet count is 52 x10 9/L. Prothrombin time is more than 1.5times Normal. Fibrinogen is 1.8g dl.

11. Mrs.Swati Patel, delivered by forceps delivery had traumatic Postpartum haemorrhage . Recognised late as had posterior fornix tear, quantified blood loss is 1500ml. No uterine atony, bleeding still present. She is tachycardic and hypotensive.

Started with packed red blood cells
Prothrombin time is 35seconds
APTT 50 seconds
What is next best blood product to be given?

12. A woman has a massive PPH and receives a transfusion of 18 units of red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate.

Her results are as follows
Blood markers are
pH >7.2
platelet count 60
APPT -45 seconds
PT -20 seconds
At the time of hysterectomy, consultant decided to give this blood product

Option List:

A. Oxytocin 5units Iv
B. Oxytocin 10unitSIM
C. Ergometrine
D. Ergometrine-Oxytocin
E. Carborpost – 4th dose to be given
F. Carbetocin
G. Consider shifting to OT
H. BLynch
I. Stepwise devascularisation
J. Hysterectomy
K. Tranexmic acid 1gm IV

Each of the above options describes various management of woman with postpartum haemorrhage. For each patient select the single most appropriate management from the list above. Each option may be used once, more than once or not at all

13. 34 year old Rebecca, into her second pregnancy, a low risk pregnancy. Which is best drug to prevent atonic PPH

14. 34 year old Rachel in her third pregnancy, low risk pregnancy. She is fully dilated and pushing, she has a history of atonic PPH in her previous delivery, what is the appropriate prophylactic drug for her?

Option List:

A. 40%
B. 1.5%
C. 20%
D. 60%
E. 50%
F. 91
G. 100%
H. 75%
I. 97%
J. 0.5%
K. 1in 200

Each of the following Options describes various Percentages on woman presenting with postpartum haemorrhage

For each patient, select the single most appropriate diagnosis from the list above. Each option may be used once, more than once or not at all.

15. A 26 year old Tesisly has delivered 6weeks back. She underwent caesarean section for prolonged rupture of membranes with suspected chorioamnionitis,
Now she has presented with heavy vaginal bleeding.
Her ultrasound shows retained membranes -she has consented for the evacuation of the uterus.
What is her chances of having uterine perforation?

16. A Sherlye, 32-year-old, primiparous and normal vaginal delivery. With the removal of placenta, she has increased vaginal bleeding

Her quantified blood loss is 1700ml.
She was managed with balloon tamponade
What percentage of woman, hysterectomy is avoided with tamponade

17. hat percentage of the woman with massive PPH needs to be notified to the risk management team?

Option List:

A. Primary Haemorrhage
B. Amniotic fluid embolism
C. Fever of unknown source.
D. Sepsis
E. Ogilvie syndrome
F. Bowel injury
G. Secondary Haemorrhage
H. Pulmonary embolism
I. Colonic obstruction
J. Mega colon
K. Mendelson syndrome
L. Sepsis secondary to wound infection
M. Paralytic ileus
N. none of the above

The above options show various complications of cesarean section,Follwing scenarios explain different women with different complications.choose appropriate  diagnosis from each option ,

Each option can be used once or more than once or none at all

18. Mrs. x primigravida , who underwent Emergency cesarean section under general anesthesia  for prolonged bradycardia .she was operated in full stomach .she had an episode of vomiting . After 6o minutes of surgery she developed cyanosis , tachycardia hypotension , bronchospasm and hypoxia Her portable Chex Ray is as follows

19. Ms. x is Primiparous who has undergone cesarean at full dilatation for failed forceps delivery .her BMI at booking was 40kg/m2.
She has history of anemia .
Today is her postop day 11, she has come with uneasiness and fever ,her wound image and Meows charts enclosed
Abdomen -soft, non tender
Minimal vaginal bleeding

20. Mrs. x , 34 year , who has undergone elective cesarean section yesterday .48 hrs back complains of abdominal discomfort and dissension.her BMI is 38kg/m2.Intraoperaive period was uneventful except that distended bowel had to be packed with moist pack .

She is on opiod analgesia now
She complains of nausea, vomiting  she not passed flatus.
On examination mild dissension , no guarding no rigidity .
Bowel sounds- absent
Her abdominal x ray enclosed .
She got better with conservative management .

21. Mrs.J, 34 yer old has undergone cesarean section  , 36hrs before , she os complaining of  progressive painless abdominal distension. Investigation shows electrolyte imbalance and rising levels of CRP. X-ray is enclosed .

Option List:

A. Mastitis
B. Pneumonia
C. Anemia
D. Arterial
E. Tissue trauma
F. Venous
G. Thrombophlebitis
H. Direct extension
I. Endometritis
J. Phlebitis
K. Pyemia
L. Teenage pregnancy
M. Poor nutrition
N. Maternal exhaustion
O. Pulmonary embolism
P. Parametritis

Above Options show various complications of postpartum period .
Below is a scenario of young postpartum girl. Choose the appropriate option for the explanation below .

Ms, saly ,is teenage girl , An 18-year-old patient finally delivered a 4,000-g Baby Vaginally by Mid cavity rotational forceps .Her antenatal. Care was complicated by anemia, poor weight gain, and maternal obesity.
Her labor was protracted, including a 3-hour second stage, a with a tear extending upto forncieal tear and a third-degree tear whcih was sutured under anaesthesia.

22. She is more prone to develop puerperal infection. Which of the following is the greatest predisposing risk factor to develop puerperal infection in this patient?

23. She develops a persistent fever of 102°F on the fourth day postpartum. What is the most likely etiology?

24. If this infection spreads to include the supporting connective tissues of the uterus, what is it called?

25. Puerperal infection may be spread by several routes.
Which of the following is the most common route that results in serious complication of a septic thrombophlebitis?