Practice Questions – Maternal Medicine EMQ

Option list:
The above labelled images show various steps of managing postpartum Haemorrhage. The following scenarios explain various scenarios of Postpartum Haemorrhage. Choose one of the option from above list. You can choose each option once or more than once or none at all.
A. Image B&E
B. Image A&C
C. Image A
D. Image E&C
E. Image D
F. Image B
G. Image D&A
H. Image C
I. Image E
J. Image C&D
K. None of the above

1. Ms. Rachel, primigravida in her first pregnancy admitted in labour room, 4cm dilated. On spontaneous rupture of membranes , heavily blood stained liquor with prolonged fetal bradycardia Is noted, on vaginal examination she is 5 cm dilated vertex high up it was decided to take for emergency cesarean section. Intra operative period, after baby extraction, she started bleeding profusely. PPH proctocol started, even after all oxytocics, uterus is still atonic, consultant decided to do traditional Compression suture which is old and most effective method which can reduce need for hysterectomy in majority of cases

2. Mrs. Tresa, 24year old woman immigrant of Asian origin, in her second pregnancy. First delivery by cesarean section. This pregnancy she is diagnosed to have grade 2 placenta Previa, planned for elective CS at 37 weeks as she was asymptomatic. Now she is 35weeks 2days. Presented with heavy bleeding decided for emergency cesarean section. Intra operative period , after baby extraction, she started bleeding profusely. PPH proctocol started, even after all oxytocics, uterus is still atonic, consultant decided to apply modified vertical compression sutures which helps in reducing uterine blood f low and compressing the bleeding surface.

Option list:
A. Labetalol oral
B. Measure blood pressure atleast 4 times a day until inpatient and then on Day 3 and Day 5 after birth and if abnormal on alternate days until normal
C. Magnesium sulphate intramuscular
D. Methyldopa oral to be stopped within 2 working days and start labetalol
E. Labetalol oral along with Aspirin 150mg
F. Labetalol intravenous
G. Monitor three times a day until discharge and follow her up in the community
H. Aspirin 150mg daily at night from 12 weeks
I. Methyldopa to be stopped within 2 workings days and continue monitoring
J. Antenatal corticosteroids
K. Transfer to the community
L. Measure Blood pressure 4 times a day while inpatient and then every 1-2 days for upto 2 weeks transfer to the community care until the woman is off treatment
M. Explain the risk of Pre-eclampsia and offer regular BP monitoring
For each scenario given above, choose the single most appropriate management option. Each option may be used once or more than once or not at all.

3. 34 year old G2P1L1 with previous normal delivery developed severe preeclampsia and was on labetalol and nifidepine and labour induced at 37 weeks. She delivered vaginally and her intrapartum period was uneventful. The most appropriate way of monitoring the blood pressure for her would be

4. 30 year old nulliparous woman at booking visit was found to have a blood pressure of 140/86, and repeat blood pressure measure again revealed 142/84. What is the treatment that she should be offered?

5. 40 year old G2P1L1 conceived following IVF, has come for a booking appointment. She gives a history of preeclampsia in the previous pregnancy. What is the recommended advice for this woman to avoid Pre-eclampsia?