Postpartum problems ( Platinum )- SBA

1. Mrs.X, grand multiparous, received massive blood transfusion, for atonic postpartum Haemorrhage. What is the recommended dose of fresh frozen plasma to be administered to prevent coagulation problems?

2. The FY1 who is incharge of the labour ward called you to review a patient who gave birth a few days earlier seems confused and delusional. They are worried that she may have postpartum psychosis.Upon reviewing the patients notes youbecome aware that patient does not have risk factors for postpartum psychosis. What percentage of patients who develop postpartum psychosis will have no history to class them at high risk?

3. An elderly primigravida presents to you with confusion and delusion post-partum. You suspect she might be having postpartum psychosis. When is the typical presentation of postpartum psychosis?

4. The FY1, in labour ward called you to review a patient who gave birth a few days earlier and seems confused and delusional. They worried that she may have postpartum psychosis.Upon reviewing the patients notes, you realize that patient does not have risk factors for postpartum psychosis. What percentage of patients who develop postpartum psychosis will have no history to class them at high risk?

5. A 24 years old patient was found unconscious by her partner following vaginal delivery 2 days earlier. She had been complaining of feeling very unwell with lower abdominal pain and had complained of offensive smelling vaginal discharge. She had vomited several times in the past 2 hours earlier. Her observations on arrival were:

• Temperature 39.8ºC
• Heart rate 140
• Respiratory rate 25
• BP 66/40

The patient is transferred to ITU following initial resuscitation in A&E but remains critically unwell. You speak to the family regarding the diagnosis of puerperal sepsis and the risk of death.Which organism is responsible for the majority of deaths from maternal infection in the UK?

6. You are reviewing a patient who delivered via ventouse 2 hours earlier. You note a bulge developed around her vagina. You suspect it’s a vulval hematoma. Which of the following vessels is responsible for a vulval haematoma?

7. You are reviewing a patient in her third pregnancy who is taking lithium for bipolar disorder but stopped when she found out she was pregnant. She has no history of postpartum psychosis. She is concerned regarding her risk of developing postpartum psychosis. What is the minimum recommended time this patient should remain under regular review postpartum?

8. A 28 years old woman is concerned her sister sustained OASIS. During her antenatal follow up she is concerned about her risk of sustaining a significant perineal tear during childbirth. You note her only previous pregnancy was delivered by term vaginal delivery and there was no third or fourth degree tear. What is the approximate incidence of 3rd and 4th degree perineal tears in multiparous women?

9. You are on rounds in postnatal ward . You review a woman who delivered vaginally 10 hours back . Her vitals are :PR 120/min , BP 90/60 mmol Hg , RR 30/ min , Temperature 38’F .what is the most likely causative organism?

10. The emergency buzzer went off in the postnatal ward & you called to see a patient who delivered 4 hours earlier via ventouse. You note a bulging haematoma has developed and patient is hypotensive. With regard to vulval haematoma’s what structure limits its spread?

11. You are ST3 incharge of the labour ward, you have been called  to see a patient who delivered 2 hours earlier via operative vaginal delivery. The midwife was concerned patient was complaining of increasing rectal and lower abdominal pain. On examination you note bulging into the vagina and suspect a paravaginal haematoma has developed. A paravaginal haematoma is bounded superiorly by which structure?

12. A 34 year old Para 4 with a BMI of 35 has just delivered a baby boy with a weight of 3.8kg. Which of the following is the most appropriate drug to give at this stage as prevention for postpartum hemorrhage?

13. A patient comes to your clinic after an uncomplicated delivery.Her baby 3 days currently & she is not breastfeeding and would like a immediate long acting contraception. She is asking about the coil. When would be the safest time to fit her with a coil?

14 . You are reviewing a G2P1 @ 34weeks POA who come to you to discuss mode of delivery. You noticed in her previous pregnancy she sustained a third degree tear. What percentage of women who sustain a third or fourth degree tear at their first birth will choose for elective Caesarean section for the birth of their second child?

15.  A 30 year old patient comes to EPAU for review after having a threatened miscarriage. She is 8 weeks pregnant now. She has B Thalessemia antenatally and had a splenectomy 3 years ago. Her current platelet count is 450 x 10³/ml. What would you advise regarding thromboprophylaxis?

26. During your postnatal rounds a patient ask you regarding contraception. She was to take pills following the delivery of her child, she was taking progesterone only pills prior to this pregnancy and keen to continue.She is not breastfeeding. When would you advise the patient to start taking their contraceptive pill?

17. A 34 year old woman is on labour ward in latent phase of labour. Her friend recently had a forces delivery and sustained a fourth degree perineal tear. She is concerned if she has to have a forceps delivery that she will sustain a significant tear thus she has refused any  operative vaginal delivery. What is the approximate incidence of third or fourth degree tears in forceps delivery without episiotomy?

18. A 30 year old patient presents to A&E following vaginal delivery 3 days earlier. She feels unwell, complains of lower abdominal pain. She has also vomited 3 times in the past 2 hours. Her observations are as follows:

• Temperature 38.8ºC
• Heart rate 115
• Respiratory rate 18
• BP 85/62

As you arrive the A&E doctor are resusicating the intravenous cystalloids. What is the most appropriate next step in her management.

19. A primigravida is asking you during your post natal rounds regarding contraception. She is keen to start her combined contraceptive pill following the delivery of her child. She is not planning on breastfeeding. When would you advise the patient to start taking their contraceptive pill?

20.  You are called to see a patient who delivered 2 hours ago via forceps. Her blood pressure has dropped and she is tachycardic. On examination she is pale and with laboured breathing, you initiate resuscitation, upon further inspection you note there appears to be inward bulging of the superior vagina which looks like a supralevator haematoma. Injury to branches of which of the following vessels is responsible for a supralevator haematoma?

21. What is the risk level of patients with bipolar disorder for having postpartum psychosis?

22.  You are reviewing a 30 year old woman on labour ward. She has myasthenia gravis and asks you for information regarding transient neonatal myasthenia gravis (TNMT) and pregnancy risks in women with MG. Which of the following statements regarding TNMT is true?

23. Puerperal Genital hematoma can be caused by several risk factors. Which of the following is NOTa risk factor?

24. The emergency buzzer went off in the OT a 27 year old women who has ongoing bleeding after a routine LSCS. Bloods have come back showing a fibrinogen level of 1.4 g/l Which of the following is the most appropriate action?

25. You are attending a 28-year-old patient who has significant bleeding postpartum. She delivered a baby boy 4.2kg, the placenta membrane was complete and there is not genital tract trauma. You suspect uterine atony as the most likely cause.
Which of the following would be your initial step of management?