Preventing Postpartum Hemorrhage

1. From onset of postpartum hemorrhage until death can be as little as:

a) 30 minutes
b) 2 hours
c) 6 hours
d) 12 hours

2. PPH is the single most important direct cause of maternal death.

 True
False

3. The number of pregnancy-related hemorrhages each year is:

a) 1 million
b) 9 million
c) 14 million
d) 21 million

4. A sound approach to preventing PPH includes:

a) Vigilently monitor every woman immediately following birth.

b) Reserve the use of active management of the third stage of labor (AMTSL)
for those women who are at high risk of PPH.
c) During antenatal care, identify all women who are underweight and
anemic.
d) All of the above

5. The majority of cases of postpartum hemorrhage (PPH) occur within the first
24 hours after birth.

 True
False
6. Immediate PPH is most commonly due to uterine atony (failure of the uterus
to contract properly after the infant is born) and a retained placenta or
placental fragments.

 True
False

7. A retained placenta occurs if the placenta is not expelled within:

a) 10 minutes after birth of the baby

b) 30 minutes after birth of the baby
c) 12 hours after birth of the baby
d) 24 hours after birth of the baby

8. The SECOND most common cause of PPH is:

a) Ruptured uterus
b) Lacerations or tears of the cervix, vagina, or perineum
c) Coagulopathy (failure of the blood to clot)
d) None of the above

9. Woman with a ruptured uterus:

a) Should be offered permanent contraception after the emergency is over

because she is at an increased risk of rupture with subsequent pregnancies
b) Needs immediate surgery to save her life
c) May recover without surgery if there is no evidence of vaginal bleeding
d) a and b (a. Should be offered permanent contraception after the
emergency is over because she is at an increased risk of rupture with
subsequent pregnancies.
b. Needs immediate surgery to save her life).
e) a and c
10. Although anemia does not increase the risk of a postpartum hemorrhage
(PPH), it does increase the risk of mortality or severe morbidity from bleeding
after the birth.

 True
False

11. Because EVERY woman is at risk of postpartum hemorrhage (PPH), EVERY

woman and her family need to understand that bleeding is a danger sign that
needs immediate attention, as well as to develop a plan of response in case an
emergency develops.

 True
False

12. Prior to the introduction of active management of the third stage of labor
(AMTSL) into a clinic, providers must be trained in:

a) The procedure for AMTSL

b) How to prevent infection in the mother, the newborn, and the health care
provider as well as how to counsel the woman about the AMTSL procedure
c) The management of potential side effects
d) All of the above

13. Midwives job descriptions throughout the world include authorization to

administer oxytocin.

 True
False

14. Although all providers responsible for emergency obstetrical care need to be
competent in AMTSL, not every skilled attendant needs this skill.

True
 False

15. In developing AMTSL programs, indicators are not necessary for monitoring
or evaluation.

True
 False
16. The introduction of AMTSL into a clinic system requires advocacy with:

a) Policymakers
b) Community members
c) Educators and care providers
d) a and c
e) a, b, and c (Policymakers, Community members, Educators and care
providers).

17. Even though lives may be saved by using AMTSL, the net costs to the health
system are significant and must be calculated when deciding whether or not to
institute AMTSL.

True
 False

18. Ergometrine has a faster onset of action than oxytocin when given
intramuscularly.

True
 False

19. NEVER use ergometrine for women who have high blood pressure.

 True
False

20. Misoprostol is a uterotonic that does not require refrigeration and can be
administered without requiring an injection.

 True
False

21. The fourth stage of labor is the time that mother and care provider can relax
and rest in the knowledge that the mother and baby are well.

True
 False

22. During the first two hours following birth, a woman's vaginal blood loss,
pulse, blood pressure, and the firmness of her uterus should be monitored
every 15 minutes.

 True
False
23. Active management of the third stage of labor (AMTSL) is a three-part
process. Which of the following choices presents these three steps in the correct
order?

A. 1) Upon signs of separation of the placenta, use controlled cord traction to

gently deliver the placenta. 2) Administer a uterotonic to cause contraction
of the uterus. 3) Place the baby on the mother's breast to stimulate
continued uterine contractions and decrease blood loss.

B. 1) Cut the cord immediately after the birth of the baby. 2) Administer a
uterotonic drug within one minute of the birth of the baby. 3) Following the
delivery of the placenta, massage the uterus to stimulate contractions.

C. Routinely administer a uterotonic drug within one minute of the birth of

the baby. 2) During the next strong contraction, apply controlled cord
traction to deliver the placenta. 3) Massage the uterus through the
abdomen to stimulate contractions.

D. 1) Routinely administer a uterotonic drug within one minute of the birth of

the baby. 2) Have the mother push out the placenta. 3) Massage the uterus
through the abdomen to stimulate contractions.

24. Pushing to facilitate the birth should not be encouraged or facilitated until
the cervix is completely dilated.

 True
False