LearnWithTest

1 A 29-year-old primigravida develops torrential bleeding immediately after delivery of the baby. The uterus is well contracted and firm. Placenta has not yet delivered after 35 minutes. On examination, there is no uterine atony. What is the MOST likely complication of the third stage of labour?

Uterine inversion Morbidly adherent placenta Traumatic postpartum hemorrhage Uterine rupture

2 Following controlled cord traction, a woman suddenly complains of severe lower abdominal pain, collapses, and a red mass is seen protruding from the vagina. What is the immediate life-threatening third-stage complication?

Cervical tear Uterine inversion Secondary postpartum hemorrhage Retained placental fragments

3 A woman has persistent bleeding after placental delivery. The uterus is firm, but vaginal examination reveals continuous trickling of blood. What is the MOST likely diagnosis?

Uterine atony Vaginal or cervical laceration Placenta accreta Coagulopathy

4 During the third stage of labour, failure of placental separation occurs due to abnormal adherence of villi to the myometrium. Which layer is ABSENT in this condition?

Myometrium Decidua basalis Chorionic plate Amnion

5 A patient with placenta accreta develops massive hemorrhage. What is the MOST definitive life-saving management?

Manual removal of placenta High-dose oxytocin infusion Emergency hysterectomy Uterine artery embolization

6 A multiparous woman has prolonged third stage (>30 minutes) without bleeding. Uterus is relaxed and placenta is still inside. What is the BEST initial management?

Immediate hysterectomy Manual removal of placenta under anesthesia Observation only Uterine artery ligation

7 Which risk factor MOST strongly predisposes to uterine inversion during the third stage?

Short umbilical cord Excessive cord traction with atonic uterus Previous cesarean section Prolonged labour

8 A woman develops postpartum hemorrhage due to uterine atony during third stage. Which drug is CONTRAINDICATED in a patient with hypertension?

Oxytocin Misoprostol Ergometrine Tranexamic acid

9 In retained placenta, what duration after delivery defines prolonged third stage in active management?

15 minutes 20 minutes 30 minutes 45 minutes

10 A woman presents with severe postpartum hemorrhage unresponsive to uterotonics. Lab reports show prolonged PT and aPTT. What is the MOST likely underlying complication?

Uterine rupture Amniotic fluid embolism Disseminated intravascular coagulation Retained placenta

11 After delivery, placenta appears complete but patient continues bleeding. Ultrasound shows echogenic material in uterine cavity. Diagnosis?

Placenta accreta Retained placental fragments Uterine inversion Broad ligament hematoma

12 Which sign is MOST specific for uterine inversion?

Boggy uterus Severe shock disproportionate to blood loss Postpartum fever Prolonged third stage

13 What is the FIRST step in management of acute uterine inversion?

Oxytocin infusion Immediate repositioning of uterus Manual removal of placenta Hysterectomy

14 A woman develops concealed bleeding with severe pain after third stage. Uterus is firm. What complication is MOST likely?

Uterine atony Broad ligament hematoma Retained placenta Secondary PPH

15 Which condition is MOST associated with placenta accreta spectrum?

Grand multiparity Previous cesarean section Polyhydramnios Pre-eclampsia

16 A woman with severe postpartum hemorrhage does not respond to uterotonics and bimanual compression. What is the NEXT step?

Uterine tamponade Manual removal of placenta Observation Antibiotics only

17 Secondary postpartum hemorrhage most commonly results from which third-stage complication?

Uterine inversion Retained placental tissue Amniotic fluid embolism Cervical tear

18 Which clinical feature helps differentiate uterine atony from genital tract trauma?

Amount of bleeding Uterine tone on palpation Blood pressure Pulse rate

19 A woman develops sudden respiratory distress and massive bleeding during third stage. What catastrophic complication is suspected?

Pulmonary embolism Amniotic fluid embolism Uterine rupture Placenta accreta

20 Which maneuver is used to correct uterine inversion manually?

B-Lynch suture Johnson maneuver Credé maneuver Rubin maneuver

21 A placenta fails to deliver and is partially separated causing hemorrhage. This is termed:

Placenta adherens Placenta accreta Placenta percreta Placenta increta

22 Which uterotonic has the FASTEST onset of action when given IV?

Oxytocin Misoprostol Carboprost Ergometrine

23 What is the MOST effective preventive strategy for third-stage complications?

Routine episiotomy Active management of third stage of labour Delayed cord clamping only Elective cesarean section

24 In placenta percreta, placental villi invade:

Decidua only Myometrium Serosa and adjacent organs Endometrium

25 Which sign indicates concealed hemorrhage in third stage?

Visible vaginal bleeding Falling hemoglobin only Uterine enlargement with minimal bleeding Bradycardia

26 A woman develops fever and foul-smelling lochia days after delivery due to retained tissue. This complication is classified as:

Primary PPH Secondary PPH Traumatic PPH Immediate PPH

27 Which investigation best confirms placenta accreta antenatally?

CT scan MRI Ultrasound with Doppler X-ray pelvis

28 During manual removal of placenta, what is the MOST important complication to anticipate?

Uterine inversion Sepsis Uterine rupture Bladder injury

29 Which blood product is MOST critical in massive obstetric hemorrhage with DIC?

Packed RBCs only Platelets Fresh frozen plasma Cryoprecipitate

30 A woman collapses postpartum with severe hypotension but minimal bleeding. What mechanism explains this in uterine inversion?

Hemorrhagic shock Cardiogenic shock Neurogenic shock Septic shock