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CNE Questions ANSWER
SUBJECT- Post Partum Haemorrhage (PPH)
PART 1 – TOTAL 10
QUESTIONS’
Q1 When
is it considered to be secondary PPH?
Bleeding occurs during delivery to 6 hours
Bleeding occurs during delivery to 24 hours
Bleeding occurs from 24 hours postpartum till 6 weeks
✔️
Bleeding occurs during delivery to 48 hours
Q2- Post Partum Haemorrhage is defined as
Sudden bleeding after childbirth
Vaginal bleeding in excess of 300 ml after childbirth
Vaginal bleeding in excess of 500 ml after childbirth✔️
Vaginal bleeding in excess of 400 ml after childbirth
Q3- What is the most common cause of PPH?
Trauma
Retained Tissue
Thrombin
Atonic Uterus ✔️
Q4- Which type of women are at risk of
having atonic uterus after childbirth?
(More than one answer possible)
Multiparity cases ✔️
Women who previously had a cesearan
Women having bleeding disorders
Women with Polyhydramnios✔️
Q5- What are signs
of shock due to bleeding?
(More than one answer possible)
Pulse above 100 ✔️
Cold sweats ✔️
Systolic blood pressure below 90 ✔️
Temperature above 38°C
Q6- What is correct regarding PPH?
It rarely affects women with normal delivery.
It is one of the major causes of maternal death. ✔️
It will appear within the first 10 minutes after
delivery.
It’s danger is only with twin delivery cases.
Q7- If continued bleeding occurs during the fourth stage
with a contracted uterus, the cause is most likely to be:
Cervical and perineal Lacerations✔️
Placental abruptions
Uterine atony
Cervical polyp
Q8- What is true regarding blood loss?
You tend to underestimate the blood loss, because the
amount looks smaller than it really is ✔️
You tend to overestimate the blood loss, because it is
mixed with amniotic fluid and maybe urine
Q9- What are the 4 T's of PPH
Tone, trauma, tissue, thrombin ✔️
Tone, trauma, tissue, tamponade
Tone, trauma, tissue, toxins
Tone, trauma, tissue, tenderness
Q10- Is it important to measure the blood loss?
Yes, because your actions are determined by the amount of
bleeding✔️
No, it is waste of time – the blood is lost and you
should concentrate on resuscitation
PART 2 – TOTAL 10
QUESTIONS’
Q1 What would you expect to happen with the pulse and
blood pressure, if the woman is affected by the blood loss?
A. Pulse will fall and blood pressure will rise
simultaneously
B.
Blood
pressure will fall, and pulse will fall simultaneously
C.
Pulse will
rise, later blood pressure will fall✔️
D. Blood pressure will rise, later pulse will rise
Q2- Select the correct statement
about the use of Oxytocin during labour from the following-
Oxytocin is recommended:
A. Only to women having slow progress of labour
B.
Only to the
mothers having postpartum haemorrhage
C.
To all
mothers within one minute of delivery ✔️
D. As an infusion with IV fluids to all women before
delivery
Q3- How do you perform aorta
compression?
(More than one answer possible)
A. One hand as a fist compresses the aorta above the
umbilicus and slightly to the left✔️
B. The other hand is palpating the femoral artery to
make sure the pulse stops✔️
C. One hand as a fist compresses the aorta vertically
below the umbilicus
D. The other hand is in the vagina compressing from
the inside
Q4- You are alone at a
peripheral facility and have just administered drugs to manage uterine atony,
but the woman is still bleeding heavily. What is the best way to buy time to
allow the uterotonic drugs to work and for additional help to arrive?
A. I can perform aortic compression that treats an
atonic uterus.
B.
I can
perform bimanual compression which is a very effective and potentially
life-saving procedure that treats bleeding from atony✔️
C. I can use compression with gauze pads
Q5- What are parts of initial
management/ resuscitation at post-partum bleeding?
(More than one answer possible)
A. Lie woman flat, head down✔️
B. Insert 2 IV lines and give 3 litres of Ringer’s
Lactate or Normal Saline fast✔️
C. Give side-lying position to woman.
D. Give Magnesium Sulphate
Q6-What would you do within 15
minutes at moderate bleeding directly after birth?
(More than one answer possible)
A. Empty the bladder✔️
B. Apply uterine massage✔️
C. Measure Vital signs and give IV fluids✔️
D. Remove the placenta manually
Q7- What do you look for on the
maternal surface of the placenta?
A. Missing lobes✔️
B. How the cord inserts
C. Signs of green amniotic fluid
D. Missing membranes
Q8- Why is a rectal exploration
always indicated after birth?
(More than one answer possible)
A. To identify trauma to the rectal sphincter✔️
B.
To assess
the degree of perineal trauma✔️
C.
To check if
there are polyps or fistulas
D. To assess the amount of bleeding from the intestine
Q9- How do you position a
bleeding woman correctly?
A. Recovery position on the left side.
B. On the back with straight legs
C. On the back with slightly bent legs and small
pillow under the head.
D. On the back, legs up and head flat.
✔️
Q10- What is the correct
technique to give Controlled cord traction?
A. Apply counter traction on cord downward and forward
with traction on pubic bone (uterus) upward
B.
Apply
counter traction on cord upwards and forward with traction on pubic bone
(uterus) backwards
C.
At the time
of uterine contraction, Apply traction on cord downward and forward with
counter traction on pubic bone (uterus) upward ✔️
D. At the time of uterine contraction Apply traction
on cord upwards and forward with counter traction on pubic bone (uterus)
backwards.
PART 3 – TOTAL 10
QUESTIONS’
Q1 A woman presents at health facility 3 days
post-partum check-up with excessive bleeding, fever, and foul smell. How will
you manage this case of secondary PPH?
(More than one answer possible)
A.
Start IV
infusion with Inj. Oxytocin 20 IU in 1 litre of RL/NS @40-60 drops/minute✔️
B.
First wear
gloves and start exploring the uterus
C.
Suspect
infection if fever and foul vaginal discharge is present✔️
D.
Give triple
antibiotics- Cap. Ampicillin 1g oral, Tab. Metrogyl 400mg oral and Inj. ✔️Gentamycin 80mg IM stat.
Q2- A woman is bleeding heavily for 45 minutes
after birth and placenta has not yet been delivered. You are preparing for
manual removal of placenta and is about to administer pain relief. Could you do
anything in the meantime to stop the bleeding?
A.
I can apply aorta compression✔️
B.
I can repeat Misoprostol 800 mcg sublingually or
rectally
C.
I can administer Oxytocin via IV push
Q3- A woman is
bleeding heavily after birth due to uterine atony. Oxytocin is unavailable in
your facility. Which drugs could you use to manage instead?
(More than one answer possible)
A.
Inj. Ergometrine 0.2 mg IM or IV slowly✔️
B.
Tab. Misoprostol 800 mcg sublingually or rectally✔️
C.
Heat-stable Carbetocin 100 mcg IM/IV
D.
Inj. Carboprost 250 mcg IM✔️
Q4- What is the maximum dose of oxytocin for a
woman in PPH management?
A.
30 IU in 24 hours
B.
100 IU in 24 hours✔️
C.
40 IU in 12 hours
D.
10 IU in 12 hours
Q5- It is bleeding from a vaginal
trauma. What will you do to be able to suture?
A.
Compress with sterile gauze for 10 minutes to stop
the bleeding for overview prior to suturing✔️
B.
Immediately suture the best you can despite
bleeding
C.
Wait an hour patiently. Vaginal tears will most
likely stop bleeding spontaneously (and often do not even require suturing)
Q6- What are the contraindications
of Ergometrine?
(More than one answer possible)
A.
Hypertension✔️
B.
Heart disease✔️
C.
Allergy to steroids
D.
Diabetes
Q7- After initial management
of PPH and several attempts of CCT till 45 mins after delivery, if you can’t
remove the placenta completely you should:
(More than one answer possible)
A.
Perform condom tamponade✔️
B.
Continue aorta compression if still bleeding✔️
C.
Refer to a higher level health facility together
with a health professional✔️
D.
Refer to a higher level health facility
unaccompanied
Q8- 40 minutes ago, a woman gave
birth to her first child. The placenta has still not been delivered. The woman
isn’t bleeding. What do you do?
(More than one answer possible)
A.
I ensure that the bladder is empty✔️
B.
I repeat 10 IU Oxytocin IM✔️
C.
I repeat Misoprostol 800 mcg sublingually or
rectally
D.
I encourage the woman to breastfeed✔️
Q9- Why is a rectal exploration
always indicated after birth?
(More than one answer possible)
A.
To identify trauma to the rectal sphincter✔️
B.
To assess the degree of perineal trauma✔️
C.
To check if there are polys or fistulas
D.
To assess the amount of bleeding from the intestine
Q10- You have just managed to stop a
post-partum haemorrhage to due retained placental tissue in the uterus. How
will you monitor the woman after the bleeding has stopped?
(More than one answer possible)
A.
I will observe her closely every 5 minutes for the
first hour and then every 30 minutes for the next 4 hours✔️
B.
I will monitor her closely for potential
re-bleeding for 24 hours. ✔️
C.
I will continue Oxytocin infusion for at least one
hour✔️
D.
I Will focus on other clients as she is out of
danger
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