LE4- POST PARTUM Flashcards

Question

A 34 y/o G3P3 delivered a term infant 15 minutes ago and presents with heavy vaginal bleeding. Examination reveals a soft and boggy uterus on palpation. Questions: What is the most likely cause of this postpartum hemorrhage (PPH)? A. Retained placental fragments B. Trauma to the genital tract C. Uterine atony D. Coagulopathy What is the first-line management for this condition? A. Manual removal of the placenta B. Hysterectomy C. Uterine massage and uterotonics D. Balloon tamponade

Answer 1

C. Uterine atony Rationale: Uterine atony is the most common cause of postpartum hemorrhage and is characterized by a soft and boggy uterus due to insufficient uterine contraction. C. Uterine massage and uterotonics Rationale: Initial management includes uterine massage to stimulate contraction and administration of uterotonics, such as oxytocin, to enhance uterine tone and reduce bleeding.

Answer 2

B. Manual removal of the placenta Rationale: If retained placental fragments are identified and bleeding persists, manual removal of the placenta is necessary to prevent ongoing hemorrhage. C. Uterine inversion Rationale: Excessive cord traction without counter traction, especially in an atonic uterus, can lead to uterine inversion, a potentially life-threatening complication.

Answer 3

B. Apply intrauterine balloon tamponade Rationale: In cases where uterotonics and massage are ineffective, intrauterine balloon tamponade can provide mechanical compression to control hemorrhage while planning definitive treatment. C. To stimulate uterine contraction Rationale: Uterine massage helps stimulate contraction, which is critical for arresting bleeding in cases of uterine atony.

Answer 4

C. Uterine inversion Rationale: Excessive traction on the cord, especially with an atonic uterus, can lead to uterine inversion, a life-threatening complication. C. Use counter traction on the uterus during cord traction Rationale: Counter traction stabilizes the uterus and prevents inversion during controlled cord traction.

Answer 5

B. Uterine rupture Rationale: Sudden severe abdominal pain, fetal distress (late decelerations), hypotension, loss of fetal station, and irregular uterine contour strongly indicate uterine rupture, particularly in a patient with a prior cesarean section. A. Immediate cesarean delivery Rationale: The definitive treatment for uterine rupture is immediate abdominal delivery to save the fetus and prevent further complications.

Answer 6

C. Previous cesarean sections Rationale: The most significant risk factor for uterine rupture is a prior uterine surgery, such as a cesarean section. Induction with high-dose oxytocin further increases the risk. B. Perform immediate laparotomy Rationale: Laparotomy is required to evaluate the extent of rupture and to deliver the fetus rapidly, minimizing maternal and fetal morbidity.

Answer 7

B. Uterine rupture Rationale: A history of uterine surgery (e.g., myomectomy), sharp abdominal pain, hemodynamic instability, and loss of fetal station suggest uterine rupture. C. Emergent cesarean delivery Rationale: Immediate cesarean delivery is required to save the fetus and stabilize the mother. Hysterorrhaphy or hysterectomy may follow based on the extent of rupture.

Answer 8

B. Internal podalic version Rationale: Internal podalic version is a known risk factor for uterine rupture due to excessive manipulation of the uterus. C. Immediate laparotomy with possible hysterectomy Rationale: Immediate laparotomy is required to manage the uterine rupture, deliver the fetus, and address bleeding. Hysterectomy may be necessary if uterine repair is not feasible.

Answer 9

B. Partial separation of the uterine scar with intact membranes and minimal bleeding Rationale: Uterine scar dehiscence involves partial separation of the uterine scar with the membranes and peritoneum remaining intact, and bleeding is minimal. B. Surgical repair of the scar (hysterorrhaphy) Rationale: In cases of scar dehiscence, repair of the defect (hysterorrhaphy) is typically performed after delivery.

Answer 10

A. Uterine rupture (complete) Rationale: Complete uterine rupture is characterized by disruption of all uterine layers, extruding fetal parts into the abdominal cavity. Severe pain, hemodynamic instability, and loss of station support this diagnosis. C. Fetal parts extruded into the peritoneal cavity Rationale: In complete uterine rupture, the communication between the uterine and peritoneal cavities allows fetal parts to move into the abdominal cavity.

Answer 11

C. Uterine dehiscence Rationale: Uterine dehiscence involves partial separation of a previous uterine scar with intact membranes and minimal or no bleeding. A. Intact visceral peritoneum Rationale: In uterine dehiscence, the peritoneum and fetal membranes remain intact, which differentiates it from complete uterine rupture.

Answer 12

B. Uterine rupture (incomplete) Rationale: Incomplete uterine rupture involves partial disruption of the uterine wall without extruding fetal parts into the peritoneal cavity. The fetus remains intrauterine. B. Immediate cesarean delivery Rationale: Even with incomplete uterine rupture, prompt delivery via cesarean section is necessary to prevent further rupture and ensure maternal and fetal safety.

Answer 13

B. Uterine rupture (incomplete) Rationale: Incomplete uterine rupture involves partial disruption of uterine layers, with fetal parts remaining intrauterine and bleeding variable. Grand multiparity and excessive fundal pressure are significant risk factors. B. Partial disruption of uterine layers with variable bleeding Rationale: Incomplete rupture involves partial wall disruption, distinguishing it from complete rupture (all layers disrupted) and dehiscence (intact membranes).

Answer 14

B. Retained placenta Rationale: Retained placenta is defined as failure to deliver the placenta within 1 hour after delivery. The firm uterus suggests uterine tone is adequate, ruling out uterine atony. A. Perform manual removal of the placenta under general anesthesia Rationale: Manual removal under general anesthesia is the definitive treatment, ensuring the uterus is relaxed and preventing excessive trauma or uterine inversion.

Answer 15

B. Placenta accreta Rationale: The absence of a cleavage plane between the placenta and the uterine wall indicates placenta accreta, where the placenta is abnormally adherent to the myometrium. B. Stop the procedure and prepare for hysterectomy Rationale: Forceful removal in placenta accreta can lead to catastrophic hemorrhage. Hysterectomy is often required to control bleeding and prevent further complications.

Answer 16

B. To counter traction and prevent uterine inversion Rationale: The abdominal hand stabilizes the uterus to prevent uterine inversion during traction applied to the placenta. B. Sweep fingers laterally to detach the placenta along the cleavage plane Rationale: Gentle sweeping of fingers along the cleavage plane ensures safe detachment without causing trauma or uterine damage.

Answer 17

A. Placenta accreta Rationale: Focal adherence of the placenta to the myometrium suggests placenta accreta, a condition often associated with prior uterine surgery. B. Prior uterine surgery (e.g., cesarean section, myomectomy) Rationale: Prior uterine surgeries are the most significant risk factor for placenta accreta due to scarring and abnormal placental implantation.

Answer 18

C. Genital tract trauma Rationale: Persistent bleeding despite a firm uterus suggests trauma to the genital tract rather than uterine atony or retained fragments. B. Perform uterine curettage under ultrasound guidance Rationale: Curettage under ultrasound guidance ensures removal of any retained placental fragments, a common cause of ongoing postpartum hemorrhage.

Answer 19

C. Placenta increta Rationale: Placenta increta is characterized by placental villi invading into the myometrium, as seen on imaging in this case. C. Prior cesarean deliveries Rationale: Prior cesarean deliveries are the most significant risk factor for abnormal placental adherence due to scarring of the uterine wall.

Answer 20

A. Placenta accreta Rationale: Placenta accreta involves abnormal adherence of the placental villi to the myometrium due to defective decidua basalis formation, preventing separation. C. Prepare for surgical intervention (e.g., hysterectomy) Rationale: Forceful removal in cases of placenta accreta can cause life-threatening hemorrhage. Surgical management, often including hysterectomy, is typically required.

Answer 21

C. Placenta percreta Rationale: Placenta percreta involves placental villi penetrating through the myometrium to the serosa and potentially invading adjacent organs, such as the bladder. B. Severe hemorrhage requiring transfusion Rationale: Placenta percreta is associated with significant hemorrhage during delivery due to deep invasion of the placenta into uterine and extrauterine structures. Blood transfusion and surgical expertise must be prepared.

Answer 22

A. Placenta previa with accreta Rationale: Placenta previa and placenta accreta often coexist, particularly in cases of previous cesarean sections. Here, placental adherence without separation defines placenta accreta. C. Hysterectomy with surgical removal of the placenta Rationale: In cases of placenta accreta with significant bleeding, hysterectomy is often required to manage hemorrhage and ensure maternal safety.

Answer 23

B. Absence of the hypoechoic retroplacental zone on ultrasound Rationale: The absence of the hypoechoic retroplacental zone is a key sonographic feature of placenta accreta, indicating abnormal adherence to the myometrium. C. Preoperative cross-matching and blood transfusion readiness Rationale: Placenta accreta is associated with massive hemorrhage during delivery, requiring adequate preparation with blood products and a skilled surgical team.

Answer 24

B. Suture the cervical tear Rationale: Suturing is required to stop active bleeding from a cervical tear, especially when the tear exceeds 2 cm. B. Control active bleeding Rationale: The primary reason for suturing cervical tears is to control active bleeding and prevent further maternal blood loss.

Answer 25

A. Perineal skin and vaginal mucosa Rationale: First-degree lacerations involve only the perineal skin and vaginal mucosa without affecting deeper structures. B. Leave unsutured to heal by secondary intention Rationale: First-degree lacerations can be left unsutured, as healing by secondary intention reduces postpartum pain and dyspareunia.

Answer 26

B. Third-degree laceration Rationale: Third-degree lacerations extend through the perineal body and anal sphincter but do not involve the rectal mucosa. B. Immediate surgical repair with layered closure Rationale: Surgical repair is essential for third-degree lacerations to restore the integrity of the perineum and anal sphincter.

Answer 27

C. Fourth-degree laceration Rationale: Fourth-degree lacerations involve the rectal mucosa and anal epithelium in addition to the perineal body and anal sphincter. B. Restore rectal and anal function Rationale: The repair of fourth-degree lacerations aims to restore the structural and functional integrity of the rectal and anal areas.

Answer 28

B. Anterior perineal trauma Rationale: Anterior perineal trauma involves the labia, urethra, and anterior vaginal wall, distinct from posterior trauma. B. Restore urethral integrity and function Rationale: Repairing anterior perineal trauma requires careful attention to urethral integrity to prevent urinary complications.

Answer 29

B. Uterine inversion (complete) Rationale: Complete uterine inversion is characterized by a fleshy mass protruding through the external os and an empty hypogastric area due to the fundus turning inside out. C. Manual repositioning of the uterus Rationale: The definitive management of uterine inversion is manual repositioning of the inverted fundus back into its normal anatomical position.

Answer 30

B. Partial inversion Rationale: Partial inversion occurs when the uterine fundus protrudes into the uterine cavity but does not cross the cervix. C. Greater depression in the hypogastric area Rationale: In partial inversion, the hypogastric area shows a depression due to inward displacement of the uterine fundus.

Answer 31

C. Use one hand to palpate the depression and another to push the fundus upward Rationale: Manual repositioning involves palpating the depression with the abdominal hand and using the vaginal hand to gently push the inverted fundus back into position. B. To prevent uterine atony and maintain uterine tone Rationale: Uterotonics are administered after repositioning to ensure the uterus contracts and remains in place, reducing the risk of re-inversion or atony.

Answer 32

B. Surgical repositioning of the uterus Rationale: If manual repositioning is unsuccessful, surgical correction is required to restore the uterus to its normal position and control bleeding. A. Blood transfusion and IV fluids Rationale: Supportive management with fluid resuscitation and blood transfusion is essential to manage hypovolemic shock and stabilize the patient.

Answer 33

B. Fundal placental implantation Rationale: Fundal placental implantation increases the risk of uterine inversion because of the force applied during delivery. A. Premature traction on the umbilical cord before placental separation Rationale: Premature traction can pull the uterus inside out, particularly in the presence of a fundal placenta or uterine atony.

Answer 34

B. Oxytocin 10 units IM Rationale: The recommended dose of oxytocin for active management of the third stage of labor is 10 units IM, which is effective in 2–3 minutes. B. To prevent uterine atony and reduce PPH risk Rationale: Oxytocin promotes uterine contractions, thereby reducing the risk of uterine atony and subsequent postpartum hemorrhage.

Answer 35

B. To stabilize the uterus and prevent uterine inversion Rationale: Counter traction stabilizes the uterus and reduces the risk of uterine inversion during controlled cord traction. C. Pulling on the cord before placental separation Rationale: Premature traction on the umbilical cord before placental separation can lead to uterine inversion or retained placenta.

Answer 36

B. To prevent uterine atony and maintain uterine tone Rationale: Uterine massage stimulates contractions and ensures the uterus remains firm, reducing the risk of postpartum hemorrhage. C. Every 15 minutes for the first 2 hours Rationale: Regular uterine massage every 15 minutes during the first 2 hours postpartum helps monitor and maintain uterine tone.

Answer 37

B. Immediate uterine massage and oxytocin administration Rationale: Uterine massage and oxytocin are the first-line interventions for uterine atony, the most common cause of immediate postpartum hemorrhage. C. It stimulates uterine contraction and reduces bleeding Rationale: Uterine massage promotes contraction, which reduces bleeding by compressing the placental blood vessels.

Answer 38

C. It increases the risk of uterine inversion Rationale: Fundal pressure can lead to uterine inversion, particularly if the placenta has not fully separated. C. Within 1 minute of delivery of the baby Rationale: Early administration of uterotonics is the cornerstone of active management to promote uterine contraction and prevent postpartum hemorrhage.

Answer 39

B. 3 L of IV fluid Rationale: The maximum dose of oxytocin IV infusion is 3 L of fluid containing 20 units of oxytocin. Administering more can lead to water intoxication and other complications. C. Carboprost (15-methylprostaglandin) Rationale: Carboprost is contraindicated in patients with asthma as it can cause bronchoconstriction due to its prostaglandin F2-α mechanism of action.

Answer 40

B. It can cause severe hypertension Rationale: Ergometrine is contraindicated in preeclampsia as it causes vasoconstriction, potentially leading to severe hypertension or stroke. C. Misoprostol rectally Rationale: Misoprostol is safe for use in patients with preeclampsia and effectively promotes uterine contraction through prostaglandin action.

Answer 41

B. 2 mg Rationale: Carboprost is administered at 0.25 mg every 15 minutes, with a maximum total dose of 2 mg (8 doses). B. Carbetocin IM Rationale: Carbetocin is a synthetic oxytocin analogue that provides prolonged uterine contraction and is a valid alternative for refractory bleeding.

Answer 42

C. 800–1000 µg Rationale: The standard dose of misoprostol for PPH is 800–1000 µg, typically administered rectally for optimal absorption. A. Direct stimulation of myometrial contraction through prostaglandin E1 action Rationale: Misoprostol is a prostaglandin E1 analogue that directly stimulates myometrial contraction to reduce uterine bleeding.

Answer 43

A. Longer duration of action Rationale: Carbetocin is a synthetic long-acting oxytocin analogue, providing sustained uterine contraction for up to 24 hours compared to oxytocin's shorter duration. C. Severe cardiac disease Rationale: Carbetocin, like oxytocin, is contraindicated in patients with severe cardiac disease due to its cardiovascular effects.

Answer 44

B. Compressing uterine sinuses to reduce blood flow Rationale: Bimanual uterine compression reduces blood flow by compressing the open uterine sinuses and angulating the uterine arteries, effectively controlling bleeding. A. Uterine and ovarian arteries Rationale: The uterine artery supplies 90% of the uterine blood flow, with the ovarian artery contributing 10%. Compression reduces flow from these arteries, controlling hemorrhage.

Answer 45

B. Apply abdominal aortic compression Rationale: If bimanual compression is not fully effective, abdominal aortic compression is a temporary measure to reduce uterine blood flow until definitive treatment is available. B. Temporarily reduces blood flow to the uterus by compressing the abdominal aorta Rationale: Aortic compression reduces blood flow to the uterus by occluding the aorta, which limits hemorrhage while further interventions are prepared.

Answer 46

B. Insufficient pressure on the abdominal aorta Rationale: Palpable femoral pulses indicate that aortic compression is not effectively reducing blood flow to the uterus. B. Apply more downward pressure until the femoral pulse is no longer palpable Rationale: Effective aortic compression requires sufficient pressure to obliterate the femoral pulse, ensuring blood flow to the uterus is minimized.

Answer 47

B. To reduce both uterine blood flow and venous pooling Rationale: Bimanual compression reduces venous pooling in uterine sinuses, while aortic compression reduces arterial blood supply, synergistically controlling bleeding. A. Until the patient stabilizes or definitive interventions are performed Rationale: Aortic compression is a temporary measure to control bleeding and stabilize the patient until surgical or other definitive management is available.

Answer 48

C. It is a temporary measure and does not address the underlying cause Rationale: Aortic compression provides temporary control of bleeding and buys time for definitive interventions to address the cause of hemorrhage. A. Uterine artery embolization Rationale: After stabilization, definitive interventions like uterine artery embolization or surgical procedures should be performed to achieve long-term bleeding control.

Answer 49

B. Temporarily arrest bleeding by applying pressure to uterine sinuses Rationale: Uterine tamponade works by exerting direct pressure on the open uterine sinuses, thereby controlling bleeding. A. Lower risk of infection and concealed bleeding Rationale: Balloon tamponade is preferred due to its lower risk of infection and concealed hemorrhage compared to traditional uterine packing.

Answer 50

C. 24–48 hours Rationale: The balloon is typically left in place for 24–48 hours to allow hemostasis before being gradually deflated. B. Gradual deflation over 24–48 hours Rationale: Gradual deflation ensures that bleeding does not resume and allows the uterus to contract fully.

Answer 51

B. Perform uterine artery embolization or surgical intervention Rationale: Persistent bleeding despite tamponade indicates a need for more invasive procedures, such as uterine artery embolization or surgery. B. Perform hysterectomy Rationale: Hysterectomy is the definitive treatment for life-threatening hemorrhage that does not respond to conservative measures.

Answer 52

B. Normal saline Rationale: The condom or balloon is inflated with 250–500 mL of normal saline to achieve hemostasis. B. Balloon tamponade conforms to the uterine contour, distributing pressure evenly Rationale: Balloon tamponade is effective because it conforms to the uterine shape, providing even pressure and minimizing the risk of concealed bleeding or infection.

Answer 53

B. By observing reduced vaginal bleeding Rationale: The effectiveness of balloon tamponade is indicated by a significant reduction or cessation of vaginal bleeding. C. Concealed hemorrhage Rationale: Unlike uterine packing, balloon tamponade has a lower risk of concealed hemorrhage because the device conforms to the uterine contour and does not obstruct the outflow of blood.

Answer 54

B. Provides vertical compression of the uterine walls to arrest bleeding Rationale: The B-Lynch suture exerts vertical compression on the anterior and posterior uterine walls, effectively controlling bleeding by tamponading the vascular sinuses. B. Higher risk of bowel entrapment during uterine involution Rationale: The B-Lynch technique involves vertical sutures that pose a higher risk of trapping bowel loops during uterine involution.

Answer 55

B. Better compression and reduced risk of bowel entrapment Rationale: Pereira sutures provide enhanced uterine compression with both longitudinal and transverse sutures, reducing the risk of bowel or omental entrapment. B. Uterine arteries and vascular sinuses Rationale: Pereira sutures collapse the ascending uterine branches and compress the vascular sinuses to control bleeding effectively.

Answer 56

C. Bowel loop entrapment during uterine involution Rationale: B-Lynch sutures are associated with a higher risk of bowel entrapment, especially during uterine involution, due to the vertical compression technique. B. Application of Pereira sutures instead of B-Lynch sutures Rationale: Pereira sutures have a lower risk of bowel entrapment because of their comprehensive placement and better uterine wall coverage.

Answer 57

B. Uterine atony refractory to medical management Rationale: Uterine compression sutures are indicated in cases of uterine atony and other causes of PPH when medical management fails to control bleeding. B. Preserves uterine anatomy and fertility Rationale: Compression sutures conserve the uterus, making them a preferred option in women who wish to preserve fertility.

Answer 58

B. Bowel entrapment and strangulation Rationale: B-Lynch sutures, being vertical, carry a higher risk of bowel or omental entrapment during uterine involution compared to Pereira sutures. B. Better suture placement and reduced tissue trauma Rationale: Pereira sutures involve longitudinal and transverse placement, ensuring better coverage and reduced trauma, which lowers the risk of infection.

Answer 59

C. Temporary occlusion of bleeding vessels using embolic agents Rationale: Arterial embolization involves placing embolic materials in the target vessels to temporarily occlude blood flow and control hemorrhage. C. It preserves fertility while controlling bleeding Rationale: Arterial embolization is a minimally invasive procedure that preserves the uterus, making it ideal for patients who wish to maintain fertility.

Answer 60

C. Localized hematoma and infection Rationale: Localized fever, pain, and swelling at the catheter site are common complications due to hematoma or mild infection post-procedure. C. Ensure proper aseptic technique and skilled operator intervention Rationale: Proper aseptic technique and expertise during catheter insertion reduce the risk of infection and procedural complications.

Answer 61

A. Buttock ischemia Rationale: Buttock ischemia is a rare but serious complication due to accidental embolization of gluteal artery branches. B. Accidental embolization of branches supplying the gluteal region Rationale: Misplacement of embolic material can block blood flow to the gluteal arteries, leading to ischemia in the buttock region.

Answer 62

B. Fluoroscopy Rationale: Arterial embolization is performed under fluoroscopic guidance, allowing real-time visualization of the target vessels. B. 45–60 minutes Rationale: The actual embolization process takes approximately 45–60 minutes, though the total procedure time may extend to 1–3 hours.

Answer 63

C. It preserves reproductive function Rationale: Arterial embolization is fertility-preserving, making it an excellent alternative to hysterectomy for women desiring future pregnancies. B. Uterine necrosis Rationale: Uterine necrosis is a rare but serious long-term complication caused by excessive or improper embolization, leading to ischemia of uterine tissue.

Answer 64

B. Reducing arterial pulse pressure by 85% to promote clot formation Rationale: Internal iliac artery ligation reduces the pressure in the pelvic vasculature, allowing clot formation and hemostasis. A. Isolation of the ureter during the procedure Rationale: The ureter lies close to the internal iliac artery and must be carefully isolated to prevent injury during ligation.

Answer 65

C. 90% Rationale: The uterine arteries provide 90% of the uterine blood supply, making their ligation highly effective for hemorrhage control. B. 2–3 cm medial to the ascending uterine artery Rationale: Sutures are placed medial to the ascending uterine artery to avoid damaging the artery directly and to effectively reduce blood flow.

Answer 66

B. 10% Rationale: The ovarian arteries contribute approximately 10% of the uterine blood supply and are targeted when uterine artery ligation is insufficient. B. High on the uterine fundus, just below the utero-ovarian ligament Rationale: Ovarian artery ligation is performed at the anastomosis of the ovarian and uterine arteries, close to the utero-ovarian ligament.

Answer 67

B. Intractable hemorrhage unresponsive to conservative measures Rationale: Hysterectomy is a last-resort intervention for postpartum hemorrhage when all conservative and surgical measures fail. B. Loss of reproductive potential Rationale: The main disadvantage of hysterectomy is that it permanently eliminates fertility, which may not be acceptable to all patients.

Answer 68

A. Reduced operative time compared to laparotomy Rationale: Transvaginal uterine artery ligation avoids the need for laparotomy, reducing operative time and morbidity. C. 96% Rationale: Bilateral uterine artery ligation has a reported success rate of over 96% in controlling postpartum hemorrhage.

Answer 69

B. Uterine subinvolution Rationale: Late PPH is often caused by uterine subinvolution due to infection, retained placental fragments, or poor healing of the placental site. B. Antibiotics and uterotonics Rationale: Uterotonics promote uterine contraction, and antibiotics treat any underlying infection contributing to subinvolution.

Answer 70

B. 15–25% Rationale: Blood loss of 750–1,500 mL corresponds to 15–25% of total blood volume, indicated by a pulse rate >100/min and urine output of 20–30 mL/hr. B. Volume replacement with crystalloids Rationale: For 15–25% blood loss, fluid resuscitation with crystalloids is the first step before considering blood transfusion if bleeding persists.

Answer 71

C. 30–40% Rationale: Blood loss of 1,500–2,000 mL corresponds to 30–40% blood volume loss, presenting with hypotension, tachycardia >120/min, and oliguria. C. Immediate blood transfusion Rationale: For 30–40% blood loss, blood transfusion is required to restore circulatory volume and oxygen-carrying capacity.

Answer 72

C. >40% Rationale: Blood loss >2,000 mL corresponds to >40% blood volume loss, presenting with severe hypotension, marked tachycardia, anuria, and lethargy. B. Blood transfusion and surgical intervention Rationale: Immediate blood transfusion is needed for hemodynamic instability, and surgical intervention may be required if conservative measures fail.

Answer 73

B. Retained placental fragments Rationale: Retained placental fragments are a common cause of late PPH and are associated with an enlarged, tender uterus and persistent bleeding. B. Immediate surgical curettage Rationale: Curettage removes retained placental tissue, which is the source of bleeding. Antibiotics may also be administered to prevent or treat infection.

LE4- POST PARTUM Flashcards

(97 cards)