COMPLICATIONS OF 3

RD
STAGE
As regard rupture uterus, all the following are correct, except:
A. Multiparity is a risk factor.
B. Abruptio placenta is a common differential diagnosis.
C. Preservation of the uterus is difficult to be done.
D. Fetus is always in the peritoneal cavity.
Shock is out of proportion to the amount of bleeding in :
a !ry postpartum haemorrhage
b "etained placenta
c Acute puerperal inversion of uterus
d #ypofibrinogenemia
Complications of the third stage of labor include:
A. "upture uterus.
B. Postpartum hemorrhage.
C. Puerperal sepsis.
D. "etained placenta.
$. %bstetric shock.
Postpartum hemorrhage:
A. &s defined as e'cessive blood loss during or after the third stage of labor.
B. &s one of the main causes of maternal mortality in developing countries.
C. &s classified into atonic and traumatic.
D. (he average amount of blood loss with cesarean section is )** cc.
$. +acerations are the main cause.
Primary postpartum hemorrhage:
A. Can occur during the first week after delivery.
B. Can occur during the third stage of labor.
C. &s usually due to a coagulation defect.
D. &s commonly due to uterine inertia.
$. May be due to retained parts of the placenta.
Causes of primary postpartum hemorrhage include:
A. Atony due to prolonged labor.
B. "upture uterus.
C. #ypofibrinogenemia associated with missed abortion.
D. Atony due to prolonged anesthesia or e'cessive analgesia.
$. "etained parts of the placenta.
Management of primary postpartum hemorrhage includes:
A. Correction of the general condition.
B. Delivery of the placenta is postponed after stoppage of bleeding.
C. &n,ection of prostaglandins $- *.-) intramyometrial.
D. (otal hysterectomy.
$. +igation of the internal iliac artery.
Manual removal of the placenta:
A. &s done under local anesthesia.
B. May be done in cases of retained placenta.
C. May be done in cases of atonic postpartum hemorrhage.
D. &s the best management in cases of placenta accreta.
$. &s done in all cases of placenta previa.
A ! years old patient presented with moderate to severe post partum hemorrhage,
the placenta was still not delivered, management should include:
A. Correction of the general condition.
B. Monitoring of vital signs and urine output.
C. Crede method to deliver the placenta.
D. %'ytocin drip.
$. Prostaglandin F- alpha &..
A " years old patient, #$ P% presented with severe post partum hemorrhage, the
placenta was already delivered, management options include:
A. Correction of the general condition.
B. $rgometrine &..
C. $'ploration of birth canal.
D. Brandt Andrews method.
$. #ysterectomy.
Causes of secondary postpartum hemorrhage include:
A. /terine atony.
B. "etained part of the placenta.
C. Choriocarcinoma.
D. .aginal and perineal lacerations.
$. &nfected C0 wound.
&etained placenta:
A. &s defined as failure of delivery of the placenta for one hour after delivery of
the fetus.
B. &t complicates -1 of all deliveries.
C. (he main cause is atony.
D. Placenta accreta is more common with previous cesarean section.
$. Bleeding is an uncommon presentation.
Placenta accreta:
A. &s more common with placenta previa.
B. &s more common with cesarean section scar.
C. (he villi commonly reach the peritoneal coat of the uterus.
D. May re2uire hysterectomy.
$. &s easily managed by manual removal of the placenta.
Placenta accreta may be associated with:
A. Placenta previa.
B. /terine scar.
C. Placental insufficiency.
D. Post partum hemorrhage.
$. Ante partum hemorrhage.
Management of retained placenta:
A. $rgometrine should not be given.
B. (he problem is not encountered with cesarean section.
C. Manual removal of the placenta is successful in the ma,ority of cases.
D. 0ome cases of placenta accreta re2uire hysterectomy.
$. (he retained part of the placenta may form a placental polyp or
develop choriocarcinoma.
'ypofibrinogenemia and ()C:
A. Fibrinogen level normally decreases during pregnancy.
B. &mportant causes of hypofibrinogenemia include concealed accidental
hemorrhage and septic shock.
C. (he process of D&C is initiated by release of thromboplastin into the
maternal circulation.
D. Bleeding time is prolonged while coagulation time remains within normal range.
$. 3iener test does not re2uire a laboratory.
'ypofibrinogenemia and ()C:
A. FDPs are decreased.
B. (he main line of treatment is fresh blood transfusion.
C. Fibrinogen is given in a dose of 45!* mg. &..
D. Antifibrinolytics are given if there is evidence of decreased fibrinolytic activity.
$. #eparin may be given prophylactically.
Acute puerperal inversion:
A. &s commonly iatrogenic.
B. %ccurs only when the uterus is la'.
C. (he placenta should be removed before reposition of the uterus.
D. Commonly re2uires hysterectomy.
$. May be associated with shock.

Shock in obstetrics:
A. &s usually of the surgical type.
B. &s commonly associated with vagal stimulation.
C. &rreversible shock is due to paralysis of the post capillary sphincter.
D. May occur with apparently normal blood pressure.
$. 6eurogenic type is due to failure to maintain the peripheral vascular resistance.
*actors contributing to development of shock include:
A. Anemia.
B. #ypervolemia associated w7ith pregnancy.
C. Ante partum hemorrhage.
D. Preeclampsia and eclampsia.
$. Prolonged labor.
Clinical picture of hemorrhagic shock:
A. #ypotension.
B. +oss of consciousness.
C. "apid weak pulse.
D. Pallor.
$. Polyuria.
Clinical picture of septic shock:
A. #ypotension.
B. (achycardia in proportion to fever.
C. Fever.
D. Pallor.
$. %liguria or anuria.
Management of hemorrhagic shock:
A. 0emi sitting position.
B. 3armth to decrease o'ygen re2uirements.
C. Morphia to relieve irritability.
D. "eplacement by crystalloids and blood transfusion.
$. Monitoring of vital signs.
Management of hemorrhagic shock+ ,:
A. Fowler8s position.
B. %'ygen administration to minimi9e tachypnea.
C. Corticosteroids in small doses.
D. Plasma: to avoid the potential risks of blood transfusion.
$. Monitoring of C.P through a catheter inserted in the &.C.
Management of septic shock:
A. $levation of the patient8s legs to increase venous return.
B. 3armth to decrease o'ygen re2uirements.
C. Antibiotics.
D. Blood transfusion.
$. Monitoring of urine output.
)ndications of blood transfusion in obstetrics:
A. Ante partum or post partum hemorrhage.
B. #emoglobin level below ; gm 1.
C. 0eptic shock.
D. $rythroblastosis fetalis.
$. 0evere preeclampsia or eclampsia.
Potential complications of blood transfusion:
A. Ma,or anaphylactic reaction.
B. Pyrogen reaction.
C. Polycythemia.
D. Circulatory overload.
$. (ransmission of hepatitis.
Amniotic fluid embolism:
A. &s not uncommon.
B. (he ma,ority of cases are associated with placental abruption.
C. Mortality reaches up to 7*1.
D. Presents as dyspnea< cyanosis< tachypnea< tachycardia and hypotension.
$. Management re2uires correction of shock and treatment of D&C.
Primary postpartum hemorrhage is associated with:
! 5 Placenta previa.
-5 Polyhydramnios.
75 Forceps delivery.
45 (he use of tocolytic agents.
)5 Prolonged labor.
)n the absence of an obvious vaginal hemorrhage, postpartum collapse may be due
to:
!5 A ruptured uterus.
-5 /terine inversion.
75 Amniotic fluid embolism.
45 A paravaginal hematoma.
)5 $clampsia.
Amniotic fluid embolism:
! 5 Causes cyanosis.
-5 Commonly caused by accidental hemorrhage.
75 &s complicated by disseminated intravascular coagulopathy.
45 &s a complication of the puerperium.
)5 Commonly caused by placenta previa.
Coagulation failure is an important complication of:
! 5 Amniotic fluid embolus.
-5 =ram5negative septicemia.
75 Abruptio placenta.
45 Placenta previa.
)5 "uptured ovarian cyst with pregnancy.
74- Primary postpartum hemorrhage, all are true EXCEPT:
A &s defined as a blood loss of greater than )** ml within the first 4> hours after
delivery
B /terine atony is the commonest cause
C &s associated with uterine fibroids
D &s associated with cervical< vaginal or perineal tears
75- Placenta accreta, the following are false EXCEPT:
A &s associated with a previous caesarean section scar
B &s characteri9ed by profuse bleeding immediately after delivery of the fetus
C 0hould be removed 8piecemeal8 under general anesthesia
D (here is always penetration of the serosa by chorlonic villi
$ &s an etiological? factor in amniotic fluid embolism
2- Postpartum hemorrhage , all are T!"E EXCEPT :#$%&' &()* +&,&-./
A is defined as genital tract bleeding in e'cess of )** ml from delivery of the fetus
until si' weeks after the birth
B is associated with placenta previa
C is associated with placental abruption
D is associated with hydramnios
20- Primary post-partum hemorrhage is associate1 with all EXCEPT:
A Multiple pregnancy.
B "etained placenta.
C $rgometrine administration.
D Polyhydramnios.
$ Cervical tear
22- 2est imme1iate treatment of se3ere post-partum hemorrhage after
1eli3ery of a complete placenta:
A &. $rgometrine
B Blood transfusion
C $vacuation of uterus without blood transfusion
D /terine artery ligation
$ Aortic compression
7- Say true or false
a- Primary post partum hemorrhage may occur after prolonged labor-.
b- Primary post partum hemorrhage, bleeding must to start after delivery of the placenta-*
c- )n post/partum hemorrhage, the patient may be markedly shocked although there may
be a little vagianl bleeding-.
d- 0vacuation of the bladder is a good prophylaxis against post/partum hemorrhage-.
e- )n acute inversion of the uterus due to excessive cord traction removal of the placenta is
a must before reduction-*
f- Pathological retraction can retain the placenta-*
g- .otal placenta percreta is a common cause of post/partum hemorrhage-*
h- Placental polyp removed 1 weeks after delivery should be examined pathologically-.
i- 2igation of the uterine artery is the final step before doing hysterectomy for post/partum
hemorrhage-*
3- Chronic inversion of the uterus may present by infertility-.
k- Manual reduction of acute inversion of the uterus usually fails if the placenta is not separated-*
l- 4
st
degree inversion of the uterus is usually diagnosed by inspection-*
m- Contraction rig may result into failure of placental separation-*
n- )ncomplete rupture uterus may result into retained separated placenta-.
o- Coagulation defect may result into atonic post/partum hemorrhage-.
p- Atonic post/partum hemorrhage may develop in cases of placenta previa due to retained parts or
anemia from ante/partum hemorrhage-.
5- Placenta acreta develop due to defective layer between decidu and myometrium-*
r- &outine administration of ecbolics may result into decrease the incidence of atonic post/partum
hemorrhage-.
s- Manual separation of the placenta may result into perforation of the uterus-.
t- Crede maneuver has a high success rate especially with co/perativwe patients how relax their
abdominal wall muscles-*
u- &etained placenta may result into shock state even in absence of vaginal bleeding-.
v- Cases of atonic pos/partum hemorrhage, bleeding is usually proportionate to the amount of
vaginal bleeding-*
w- Augmentation of labor may result into atony if oxytocin is stopped in post/partum period-.
x- Cases of chronic inversion of the uterus may be due to 6bstetrics or #ynecological causes-.
y- .he best management of total placenta accrete is piece meal cutting of the placenta-*
7- #el foam emboli7ation of the common iliac arteries is recently tried to manage cases of atonic
post/partum hemorrhage-*
(1)Post partum haemorrhage is defined as:
A) Loss of more than 500mls of blood after vaginal delivery.
B) Loss of more than, 1000mls of blood after caesarian section.
C) Loss of blood that affects the general condition of patient.
D) A!B).
") A!B!C).
(2)The leading cause of maternal mortality in Egypt is:
A) Antepart#m haemorrhage.
B) $ostpart#m haemorrhage.
C) $#rperal sepsis.
D) Abortion% haemorrhage.
(3)Placental- site postpartum haemorrhage is NOT caused
y:
A) Constriction ring.
B) Atony of #ter#s.
C) Cervical laceration.
D) Adherent placenta.
(!)"issiminated intra#ascular clotting$ is NOT encountered
in:
A) Abr#ptio placenta.
B) &hreatened abortion.
C) 'issed abortion left for more than fo#r (ee)s.
D) Amniotic fl#id embolism.
(%)"issiminated intra#ascular clotting$ is NOT diagnosed y:
A) "stimation of fibrinogen in blood.
B) &#be clotting test.
C) &otal * differential (hite co#nt.
D) "stimation of fibrinogen degradation prod#cts.
(&)"issiminated intra#ascular clotting is NOT T'E(TE" y:
A) +ibringen in,ection.
B) &ransf#sion of do#ble% strength plasma.
C) -terine artery ligation. or emboli/ation.
D) &rane0emic acid anti plasmin) in,ection.
())Ecolics$ used in the managementof atonic postpartum
haemorrhage$ are the follo*ing$ E+,EPT:
A) 10ytocin.
B) 'ethergin.
C) 'ifeprestone.
D) 'esoprostol.
") $rostaglandin +2.
(-).n the treatment of postpartum haemorrhage$ one of the
follo*ing is to e discouraged:
A) Brandt% Andre(3s techni4#e.
B) Crede3s manae#vre.
C) 'an#al separation of the placenta.
D) Biman#al compression.
") -terine massage.
(/).n dealing *ith the general condition of a case of
postpartum haemorrhage$ the follo*ing should e
measured$ E+,EPT:
A) 5aematocrit val#e.
B) -rine o#tp#t.
C) 6edementation rate.
D) Coag#lation profile.
") Liver f#nction tests.
(10).n manual separation of the placenta$ the right hand is
introduced through the #agina to the uterus1 There it is:
A) 7ntra#terine intra% amniotic.
B) 7ntra#terine e0tra%amniotic.
C) 8ot important.
(11).n the case of cer#ical laceration$ *hich statement is NOT
T'2E:
A) Lateral laceration may in,#re the #terine vessels.
B) Ann#lar detatchment is associated (ith severe bleeding.
C) B#c)et% handle tears often occ#r after intra%amniotic in,ection of
postaglandins.
D) 8one of the above.
(12),er#ical laceration may result in the follo*ing$(3ar4 the
5'ON6 statement):
A) "0cessive bleeding.
B) Cervical incompetence.
C) Broad ligament haematoma.
D) 7nvolvement of the lo(er #terine segment.
") 8one of the above.
(13),olporrhe7is indicates:
A) Lateral cervical laceration.
B) 7n,#ry to the vaginal forni0 or fornices.
C) 7n,#ry to the perine#m (ith involvement of anal sphinter.
D) 7n,#ry to the v#lva (ith involvement of the fren#lar artery.
(1!).n cer#ical laceration$ the site affected is 3O8T9: at:
A) 9 1:cloc).
B) ; 1:cloc).
C) < 1:cloc).
D) 12 1:cloc).