Obstetric Haemorrhage Quiz

1. Post Partum Haemorrhage

A Primary PPH - Loss of 500 ml or more within 24 hours of a delivery B Severe PPH - Loss of more than 2000ml C Secondary PPH - excessive bleeding within 2 wks of delivery D Is prevented by Syntocinon E Is commonly seen following a twin delivery TTFTT

2. PPH protocol should be commenced

A when the blood loss is about 500ml in an otherwise healthy mother B in the presence of continuous bleeding C In a mother with significant heart disease with a 500ml blood loss D when the blood loss is about 1000ml E in the presence of clinical features of shock FTTTT

3. Called to the labour ward to help resuscitate a bleeding mother

A if not busy you will run to the ward B as soon as you see the patient you will run to the phone to inform seniors C while resuscitating the mother you will ask a nurse to inform your consultant D your first priority would be ABC of resuscitation E when she is stabilized you take her to OT TFTTT

4. In the management of a severe haemorrhage

A Resuscitation should be the last B Surgical intervention should be done after initial resuscitation C Ergometrine is useful D Communication saves time E Communication, resuscitation, monitoring and investigations & arresting the bleeding should be done simultaneously FTTTT

5.Volume replacement in an unexpected severe haemorrhage

Rapid infusion with14G cannulae Both crystalloids & colloids should be given Blood should be given as early as possible There is no place for uncross matched blood E A pressurized bag is useful TTTFT A B C D

6. Following personnel should be called in a major obstetric haemorrhage

A

B C D E

Experienced nurse & midwife Extra house officer/officers Obstetric SHO/Registrar/ SR Anaesthetic MO/ Registrar/ SR JMO TTTTF

7.Following members of the staff should be alerted in a severe obstetric haemorrhage A B C D E Consultant Obstetrician Consultant Anaesthetist Consultant Haematologist Staff of the blood bank Consultant Physician TTTTF

8.What should we do in a major obstetric haemorrhage ?

A Give Oxygen by mask at 1015 litres/minute B Intravenous access (14-gauge cannulae) C Elevate the patients legs D Give 10 Litres of crystalloids fast E Transfuse blood as soon as possible TTTFT

9.Clinical features of a severe obstetric haemorrhage are

A B C D E tachycardia normal blood pressure pallor thirst reduced urine output TFTTT

10. Assessment of blood loss in a post partum haemorrhage

A B C D E is difficult visual estimate is not very accurate is guided by clinical signs & symptoms is a useless exercise should be taught to nurses TTTFT

11. Therapeutic goals of management of a massive blood loss are to achieve a

haemoglobin > 14g/dl platelet count > 75,000/dl prothrombin time < 1.5 x mean control activated partial thromboplastin time < 1.5 x mean control E MAP ( Mean Arterial Pressure ) of 65 to 70mm Hg FTTTT A B C D

12. Recommended fluids for initial resuscitation in a PPH include

A B C D E 5% Dextrose solution 0.9% NaCl Hartmanns solution Tetrastarch Hetastarch FTTTT

13. Which Anaesthetic?

A Spinal Anaesthesia - major degree posterior placenta praevia B General Anaesthesia - placenta accreta D Spinal anaesthesia - mild antepartum haemorrhage E General Anaesthesia severe PPH F Spinal Anaesthesia - severe secondary PPH TTTTF

Drugs for Induction of Anaesthesia in a PPH

A B C D E Thiopentone Sodium & Atracurium Thiopentone Sodium & Suxamethonium Etomidate & Suxamethonium Ketamine & Suxamethonium Midazolam & Suxamethonium
FTTTT

14. Blood transfusion in a major obs haemorrhage

A Should always be with cross matched blood B Can give uncross matched group specific blood C Uncross matched O negative blood is given D FFP is given as 15ml/Kg E One unit of platelets will increase the count by about 10,000 FTTTT

15. Obstetric management of a severe haemorrhage may consist of

1. Bi manual massage 2. Balloon tamponade 3. Uterine artery ligation 4. Aortic cross clamping 5. Caesarean Hysterectomy TTTFT

Following required to anaesthetize a mother with a PPH?

A B C D E Two good working laryngoscopes IV access with large bore cannulae Mothers Consent A good assistant Basic monitoring TTFTT

LSCS and an Anticipated PPH

A B C D E Inform Seniors beforehand Inform patient about possible ICU care Discuss with relatives Cross match 6 units of blood Advice to transfuse 4 units of FFP in the ward TTTTF