Multiple Choice Questions On Puerperium

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Multiple Choice Questions On Puerperium - Quiz

Are you working as a health professional? Do you have any idea about the puerperium or puerperal period? Attempt these multiple-choice questions on puerperium and evaluate how well you know about this maternal period. The puerperium, also known as the postpartum period, is a six-week period after childbirth during which the mother's hormones return to their normal state. Play the below quiz and learn more about the postpartum period in detail to make your medical career successful. All the best!


Questions and Answers
  • 1. 

    A previously energetic woman complains of crying, loss of appetite, difficulty in sleeping, and feeling of low self-worth, beginning approximately 3 days after a normal vaginal delivery. These feelings persisted for approximately 1 week and then progressively diminished. Which of the following is the best term to describe her symptoms postpartum?

    • A.

      Blues

    • B.

      Manic depression

    • C.

      Neurosis

    • D.

      Psychosis

    • E.

      Schizoid affective disorder

    Correct Answer
    A. Blues
    Explanation
    The term "blues" is the best term to describe the woman's symptoms postpartum. The symptoms of crying, loss of appetite, difficulty in sleeping, and feeling of low self-worth are consistent with the postpartum blues, also known as the baby blues. This is a common condition that affects many women after giving birth and is characterized by mood swings, sadness, and emotional instability. The symptoms typically start within the first few days after delivery and usually resolve on their own within a week or two.

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  • 2. 

    A patient has just delivered her first child after an uncomplicated pregnancy and term vaginal delivery. She is anxious to breast-feed. As part of her postpartum discharge counseling, she should be told that few things interfere with lactation, but she should avoid which of the following?

    • A.

      Depo-Provera

    • B.

      Frequent suckling

    • C.

      High dose (≥50 μ gestradiol) oral contraceptive pills

    • D.

      Levonorgestrel intrauterine device (IUD)

    • E.

      Progestin-only oral contraceptive pill (minipill)

    Correct Answer
    C. High dose (≥50 μ gestradiol) oral contraceptive pills
    Explanation
    High dose (≥50 μ gestradiol) oral contraceptive pills can interfere with lactation. The other options, such as Depo-Provera, frequent suckling, Levonorgestrel intrauterine device (IUD), and progestin-only oral contraceptive pill (minipill), do not interfere with lactation.

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  • 3. 

    At delivery, a perineal laceration tore through the skin of the fourchette, vaginal mucous membrane, and the fascia and perineal muscles of the perineal body but not the anal sphincter or mucosa. This should be recorded in the medical record as what type of laceration?

    • A.

      First-degree

    • B.

      Second-degree

    • C.

      Third-degree

    • D.

      fourth-degree

    • E.

      Complete

    Correct Answer
    B. Second-degree
    Explanation
    The given scenario describes a perineal laceration that involves tearing through the skin of the fourchette, vaginal mucous membrane, and the fascia and perineal muscles of the perineal body. However, the anal sphincter or mucosa is not affected. This indicates that the laceration is a second-degree tear.

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  • 4. 

    A patient is being discharged from the hospital following an uncomplicated vaginal delivery. Discharge counseling and plans would include which of the following?

    • A.

      Discontinue prenatal vitamins

    • B.

      No driving for 4 weeks

    • C.

      No coitus for 6 weeks

    • D.

      Return to work only after 6 weeks of maternity leave

    • E.

      Rubella immunization for nonimmune patients

    Correct Answer
    E. Rubella immunization for nonimmune patients
    Explanation
    Discharge counseling and plans for a patient following an uncomplicated vaginal delivery would include rubella immunization for nonimmune patients. This is because rubella, also known as German measles, can cause severe birth defects if a pregnant woman contracts the virus. Therefore, it is important to ensure that nonimmune patients receive the rubella vaccine to protect themselves and any future pregnancies. The other options mentioned in the question are not relevant to discharge counseling after a vaginal delivery.

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  • 5. 

    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. Although all of the following can be the cause for postpartum hemorrhage, which is the mostfrequent cause of immediate hemorrhage as seen in this patient?

    • A.

      Coagulopathies

    • B.

      Retained placental fragments

    • C.

      Uterine atony

    • D.

      Uterine rupture

    • E.

      Vaginal and/or cervical lacerations

    Correct Answer
    C. Uterine atony
    Explanation
    Uterine atony is the most frequent cause of immediate hemorrhage in this patient. Uterine atony refers to the inability of the uterus to contract effectively after childbirth, leading to excessive bleeding. Given the patient's history of a previous cesarean section, the risk of uterine atony is increased. It is important to note that while all of the other options can also cause postpartum hemorrhage, uterine atony is the most common cause in this scenario.

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  • 6. 

    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. In this patient with a significant postpartum bleed, when should transfusions be started?

    • A.

      After the loss of 750 cc of blood

    • B.

      Before giving other volume expanders

    • C.

      Before using prostaglandin E2 (PGE2)-alpha

    • D.

      If the patient becomes hypotensive despite other volume expanders

    • E.

      When packed cell volume (PCV) is

    Correct Answer
    D. If the patient becomes hypotensive despite other volume expanders
    Explanation
    Transfusions should be started if the patient becomes hypotensive despite other volume expanders. This is because hypotension indicates inadequate blood volume and perfusion, which can be life-threatening. Transfusions are necessary to restore blood volume and prevent further complications. The other options are not appropriate in this scenario as they do not address the immediate need for transfusions in a hypotensive patient.

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  • 7. 

    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. After a significant period of hypovolemic shock, the bleeding was controlled and the vascular volume replaced. Estimates of blood loss were over 2,500 cc. The patient apparently recovered well. However, she was unable to breast-feed and gradually noted breast atrophy and no resumption of menses. Later, she developed constipation, slurred speech, and moderate nonpitting edema. Which of the following is the most likely diagnosis?

    • A.

      Acute tubular necrosis (ATN)

    • B.

      Amenorrhea-galactorrhea syndrome

    • C.

      Asherman’s syndrome (uterine synechiae)

    • D.

      Pituitary tumor

    • E.

      Sheehan’s syndrome (pituitary necrosis)

    Correct Answer
    E. Sheehan’s syndrome (pituitary necrosis)
    Explanation
    The most likely diagnosis in this case is Sheehan's syndrome (pituitary necrosis). This is supported by the patient's history of significant postpartum bleeding and hypovolemic shock, which can lead to ischemic necrosis of the pituitary gland. The symptoms of breast atrophy, amenorrhea, and hormonal imbalances are consistent with pituitary dysfunction. Additionally, the development of constipation, slurred speech, and nonpitting edema can be attributed to the hormonal deficiencies caused by pituitary necrosis.

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  • 8. 

    A patient calls your clinic complaining of continued heavy vaginal bleeding. She had an “uncomplicated” vaginal birth 2 weeks ago of her second child. What is the most likely diagnosis from the following differentials?

    • A.

      Coagulopathies

    • B.

      Retained placental fragments

    • C.

      Uterine atony

    • D.

      Uterine rupture

    • E.

      Vaginal lacerations

    Correct Answer
    B. Retained placental fragments
    Explanation
    The most likely diagnosis in this case is retained placental fragments. This is because heavy vaginal bleeding after childbirth can be a sign of retained placental tissue in the uterus. When the placenta does not detach completely from the uterine wall, it can lead to persistent bleeding. Other differentials such as coagulopathies, uterine atony, uterine rupture, and vaginal lacerations may also cause bleeding, but in this scenario, retained placental fragments are the most likely cause based on the patient's history of an uncomplicated vaginal birth.

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  • 9. 

    The most efficacious treatment of persistent uterine hemorrhage in the second to fourth week of the puerperium, as observed in this patient is which of the following?

    • A.

      Dilation and curettage (D&C)

    • B.

      Ergotrate

    • C.

      High doses of estrogen

    • D.

      High doses of progesterone

    • E.

      Uterine packing

    Correct Answer
    A. Dilation and curettage (D&C)
  • 10. 

    The postpartum nurse calls about a patient who had an uncomplicated vaginal delivery 12 hours ago. She is concerned that the patient has the following findings. Which of them should be of most concern to you?

    • A.

      Abdominal rigidity

    • B.

      Leukocytosis of 16,000

    • C.

      Proteinuria

    • D.

      A pulse rate of 60

    • E.

      A single temperature of 100.4°F

    Correct Answer
    A. Abdominal rigidity
    Explanation
    Abdominal rigidity after a vaginal delivery could be indicative of a serious condition such as uterine rupture or internal bleeding. This requires immediate attention and further investigation to rule out any complications. The other findings mentioned, such as leukocytosis, proteinuria, a pulse rate of 60, and a single temperature of 100.4°F, are relatively common and may not be as concerning as abdominal rigidity in this context.

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  • 11. 

    A patient had a prolonged labor requiring a C-section in the setting of chorioamnionitis. She has continued with spiking temperatures despite antibiotics and a diagnosis of postpartum pelvic thrombophlebitis is being made. She suddenly complains of chest pain and dyspnea. Which of the following tests will be most helpful to diagnose a pulmonary embolism?

    • A.

      Arterial blood gas

    • B.

      Auscultation of the chest

    • C.

      Chest x-ray

    • D.

      Electrocardiogram (ECG)

    • E.

      spiral computed tomography (CT) scan

    Correct Answer
    E. spiral computed tomography (CT) scan
    Explanation
    A spiral computed tomography (CT) scan would be the most helpful test to diagnose a pulmonary embolism in this patient. The patient's symptoms of chest pain and dyspnea, along with her history of prolonged labor and postpartum pelvic thrombophlebitis, raise suspicion for a pulmonary embolism. A spiral CT scan is a sensitive and specific test for detecting pulmonary embolisms, as it can visualize the blood vessels in the lungs and identify any blockages caused by blood clots. This test would provide the most accurate and timely diagnosis in this situation.

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  • 12. 

    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. Which of the following is the greatest predisposing cause of puerperal infection in this patient?

    • A.

      Coitus during late pregnancy

    • B.

      Iron deficiency

    • C.

      Maternal exhaustion

    • D.

      Poor nutrition

    • E.

      Tissue trauma

    Correct Answer
    E. Tissue trauma
    Explanation
    The greatest predisposing cause of puerperal infection in this patient is tissue trauma. The patient had a complicated labor, including a mid-forceps delivery with a sulcus laceration and a third-degree episiotomy. These procedures can cause damage to the tissues, increasing the risk of infection. Other factors such as anemia, poor weight gain, and maternal obesity may also contribute to a weakened immune system, making the patient more susceptible to infection. However, in this case, the tissue trauma from the delivery is the most significant factor.

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  • 13. 

    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. he develops a persistent fever of 101°F on the third day postpartum. What is the most likely etiology?

    • A.

      Cholecystitis

    • B.

      Endometritis

    • C.

      Mastitis

    • D.

      Pneumonia

    • E.

      Thrombophlebitis

    Correct Answer
    B. Endometritis
    Explanation
    The most likely etiology for the patient's persistent fever on the third day postpartum is endometritis. Endometritis is an infection of the lining of the uterus, which commonly occurs after childbirth. The patient's complicated prenatal course, prolonged labor, and delivery with laceration and episiotomy increase the risk of developing endometritis. Symptoms of endometritis include fever, abdominal pain, and foul-smelling vaginal discharge. Prompt diagnosis and treatment with antibiotics are necessary to prevent complications.

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  • 14. 

    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. If this infection spreads to include the supporting connective tissues of the uterus, what is it called?

    • A.

      Parametritis

    • B.

      Peritonitis

    • C.

      Phlebothrombosis

    • D.

      Pyemia

    • E.

      Thrombophlebitis

    Correct Answer
    A. Parametritis
    Explanation
    Parametritis refers to an infection that spreads to include the supporting connective tissues of the uterus. It is characterized by inflammation and infection of the parametrium, which is the tissue surrounding the uterus. In this case, the patient had a complicated labor and delivery, which may have increased the risk of infection spreading to the parametrium. The other options listed (peritonitis, phlebothrombosis, pyemia, thrombophlebitis) do not specifically involve the infection of the supporting connective tissues of the uterus.

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  • 15. 

    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. 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?

    • A.

      Arterial

    • B.

      Direct extension

    • C.

      Fomites

    • D.

      Lymphatic

    • E.

      Venous

    Correct Answer
    E. Venous
    Explanation
    Puerperal infection refers to an infection that occurs after childbirth. Septic thrombophlebitis is a serious complication of puerperal infection. It is most commonly spread through the venous route. This means that the infection originates in the veins and spreads through the bloodstream, causing inflammation and blood clot formation. In this case, the patient had multiple risk factors for infection, including a complicated labor and delivery, which may have contributed to the development of septic thrombophlebitis through the venous route.

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  • 16. 

    A patient who is 12 hours postpartum develops a temperature of 104°F, a tender uterus, and increased lochia without an odor. Her pregnancy course had been complicated only by limited and inconsistent prenatal care. Your antibiotic choice needs to be sure to cover which of the following organisms?

    • A.

      Bacteroides

    • B.

      Beta-streptococcus

    • C.

      Escherichia coli

    • D.

      Gonococcus

    • E.

      Staphylococcus

    Correct Answer
    B. Beta-streptococcus
    Explanation
    The patient's symptoms of a high fever, tender uterus, and increased lochia without an odor suggest an infection in the postpartum period. The most likely organism causing this infection is beta-streptococcus, also known as Group B Streptococcus (GBS). GBS is a common cause of postpartum infections and is often associated with limited and inconsistent prenatal care. Therefore, the antibiotic choice needs to cover beta-streptococcus to effectively treat the infection.

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  • 17. 

    Bacteria can be cultured from most endometrial cavities 2 to 3 days postpartum in patients who are asymptomatic. The anaerobic organism most commonly found is which of the following?

    • A.

      Beta-streptococcus

    • B.

      Clostridium

    • C.

      E. coli

    • D.

      Peptococcus

    • E.

      Peptostreptococcus

    Correct Answer
    E. Peptostreptococcus
    Explanation
    Peptostreptococcus is the most commonly found anaerobic organism in the endometrial cavities of asymptomatic patients 2 to 3 days postpartum. This suggests that Peptostreptococcus is a normal inhabitant of the endometrial cavity during this time period.

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  • 18. 

    During childbirth classes, a patient should be told which of the following regarding breastfeeding?

    • A.

      Breast milk is a major source of immunoglobulin G (IgG).

    • B.

      Most ingested drugs that are soluble in maternal blood do not cross into breast milk.

    • C.

      Mother’s milk contains a large amount of iron.

    • D.

      The postpartum period of lactation is a time of above-normal fertility.

    • E.

      Prolactin stimulates milk production and breast development.

    Correct Answer
    E. Prolactin stimulates milk production and breast development.
    Explanation
    Prolactin stimulates milk production and breast development. This hormone is responsible for initiating and maintaining lactation in the postpartum period. It is produced by the pituitary gland in response to the suckling of the baby and helps in the production of breast milk.

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  • 19. 

    A 16-year-old patient delivered a term infant yesterday. She is placing the child for adoption and is not going to breast-feed. She asks for something to suppress lactation. What is simplest and safest method of lactation suppression?

    • A.

      Breast binding, ice packs, and analgesics

    • B.

      Bromocriptine

    • C.

      Deladumone

    • D.

      Depo-Provera

    • E.

      Oral contraceptive pills

    Correct Answer
    A. Breast binding, ice packs, and analgesics
    Explanation
    Breast binding, ice packs, and analgesics are the simplest and safest methods of lactation suppression. Breast binding helps to reduce milk production by applying pressure to the breasts. Ice packs can also help to decrease milk production by reducing blood flow to the breasts. Analgesics can help to relieve any discomfort or pain associated with engorgement. These methods are non-invasive and do not involve the use of medications, making them safe options for lactation suppression in this situation.

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  • 20. 

    A patient presents 1-week postpartum with complaints of her right breast being engorged, hot, red, and painful. She reports a fever of 101 °F. If her breasts were cultured, which of the following is the most likely organism to be found?

    • A.

      aerobic Streptococcus

    • B.

      Anaerobic Streptococcus

    • C.

      E. coli

    • D.

      Neisseria

    • E.

      Staphylococcus aureus

    Correct Answer
    E. Staphylococcus aureus
    Explanation
    Staphylococcus aureus is the most likely organism to be found in the breast culture of a postpartum patient presenting with symptoms of engorgement, redness, pain, and fever. Staphylococcus aureus is a common cause of mastitis, an infection of the breast tissue, especially in breastfeeding women. It can enter the breast through cracked or sore nipples and cause inflammation and infection. The symptoms described are consistent with a Staphylococcus aureus infection.

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  • 21. 

    A class C diabetic patient delivers at term. It is important to check her blood sugar levels immediately postpartum, since there may be a decrease in the insulin requirements of diabetic patients. This can be partly explained by which of the following?

    • A.

      Decreased activity

    • B.

      Decrease in plasma chorionic somatomammotropin [hCS or human placental lactogen (hPL)]

    • C.

      Decrease in plasma estrogen

    • D.

      Decrease in plasma progesterone

    • E.

      increased food intake

    Correct Answer
    B. Decrease in plasma chorionic somatomammotropin [hCS or human placental lactogen (hPL)]
    Explanation
    After delivery, the levels of chorionic somatomammotropin (hCS or hPL) decrease. This hormone is produced by the placenta during pregnancy and acts as an antagonist to insulin, leading to insulin resistance. Therefore, a decrease in hCS or hPL levels postpartum would result in a decrease in insulin resistance and a subsequent decrease in insulin requirements for diabetic patients. This is why it is important to check the blood sugar levels immediately postpartum for class C diabetic patients.

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  • 22. 

    Immediately after the completion of a normal labor and delivery, the uterus should be which of the following?

    • A.

      At the level of the symphysis pubis

    • B.

      Boggy

    • C.

      Discoid

    • D.

      Firm and rounded

    • E.

      Immobile

    Correct Answer
    D. Firm and rounded
    Explanation
    After a normal labor and delivery, the uterus should be firm and rounded. This indicates that the uterus has contracted properly and is in a healthy state. A firm and rounded uterus also helps prevent excessive bleeding and promotes the healing process. It is important for healthcare providers to assess the firmness and shape of the uterus after delivery to ensure proper postpartum recovery.

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  • 23. 

    A patient had a vaginal delivery of a 4,500-g infant after a prolonged second stage. She is now unable to void. Each of the following could be a reason and can be initially treated with Foley placement. Which of the following can represent a most serious etiology of inability to void in the immediate postpartum period?

    • A.

      Anesthesia

    • B.

      Edema

    • C.

      Emotions

    • D.

      Hematoma

    • E.

      Overdistention of the bladder

    Correct Answer
    D. Hematoma
    Explanation
    A hematoma can represent a serious etiology of inability to void in the immediate postpartum period. Hematomas can occur due to trauma during delivery and can compress the urethra or bladder, leading to urinary retention. This can be initially treated with Foley placement to relieve the obstruction caused by the hematoma.

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  • 24. 

    Average blood loss from an uncomplicated vaginal delivery, when carefully measured, has been found to be which of the following?

    • A.

      G < 200mL

    • B.

      Approximately 350 mL

    • C.

      Approximately 550 mL

    • D.

      Approximately 750 mL

    • E.

      approximately 1,000 mL

    Correct Answer
    C. Approximately 550 mL
    Explanation
    On average, the blood loss from an uncomplicated vaginal delivery, when carefully measured, is approximately 550 mL.

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  • 25. 

    The decidual layer is divided into several parts, pregnancy. The remaining layer can be damaged with a curettage for retained placenta. Which of the following is the part that should remain?

    • A.

      Decidua capsularis

    • B.

      Decidua vera

    • C.

      Zona basalis

    • D.

      zona functionalis

    • E.

      Zona spongiosa

    Correct Answer
    C. Zona basalis
    Explanation
    During pregnancy, the decidual layer in the uterus is divided into several parts. One of these parts is the zona basalis, which is the layer that remains after a curettage for a retained placenta. This means that the zona basalis is the part of the decidual layer that should not be damaged during the procedure.

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  • 26. 

    A 20-year-old woman (gravida 1) has just delivered. After expression of the placenta, a red, raw surface is seen at the vaginal introitus. Simultaneously, the nurse states that the patient is pale and her BP is 70/40 mm Hg. External bleeding has been of normal amount. Which of the following would be the most likely diagnosis?

    • A.

      Ovarian cyst

    • B.

      Ruptured uterus

    • C.

      Second twin

    • D.

      Uterine inversion

    • E.

      Vaginal rupture

    Correct Answer
    D. Uterine inversion
    Explanation
    The most likely diagnosis in this scenario is uterine inversion. Uterine inversion occurs when the uterus turns inside out and protrudes through the cervix into the vagina. This can result in a red, raw surface at the vaginal introitus. The patient's pale appearance and low blood pressure indicate hypovolemia, which can be caused by uterine inversion due to excessive bleeding. The normal amount of external bleeding suggests that the bleeding is occurring internally, further supporting the diagnosis of uterine inversion.

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  • 27. 

    A 20-year-old woman (gravida 1) has just delivered. After expression of the placenta, a red, raw surface is seen at the vaginal introitus. Simultaneously, the nurse states that the patient is pale and her BP is 70/40 mm Hg. External bleeding has been of normal amount. Emergency treatment would initially consist of which of the following?

    • A.

      Delivery of the infant

    • B.

      exploratory laparotomy

    • C.

      Immediate hysterectomy

    • D.

      Immediate replacement of the fundus

    • E.

      massive blood transfusion

    Correct Answer
    D. Immediate replacement of the fundus
    Explanation
    Immediate replacement of the fundus is the correct answer because the patient is presenting with signs of postpartum hemorrhage, such as a pale appearance, low blood pressure, and a raw surface at the vaginal introitus. The fundus is the upper part of the uterus, and by replacing it, the healthcare provider can help control the bleeding and prevent further complications. This is the initial step in managing postpartum hemorrhage.

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  • 28. 

    A 21-year-old G1 now P1 has had a vaginal delivery of a 2,700-g infant. Her labor was complicated by severe pre-eclampsia. Bimanual massage of the uterus and intravenous oxytocin do not control her postpartum hemorrhage. What is the next best intervention?

    • A.

      B-Lynch suture

    • B.

      D&C

    • C.

      Ergotrate

    • D.

      packing the uterus

    • E.

      Prostaglandin F2 (PFG2)-alpha

    Correct Answer
    E. Prostaglandin F2 (PFG2)-alpha
    Explanation
    The next best intervention for this patient with postpartum hemorrhage that is not controlled by bimanual massage of the uterus and intravenous oxytocin is prostaglandin F2 (PFG2)-alpha. Prostaglandin F2 (PFG2)-alpha is a medication that can be used to induce uterine contractions and control bleeding. It is commonly used in cases of postpartum hemorrhage when other interventions have failed.

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  • Current Version
  • Jan 02, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Feb 27, 2018
    Quiz Created by
    Abdallah.a.aji
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