Antepartum and Postpartum Hemorrhage MCQs

Obstetrics & Gynaecology · 160 free questions with answers & explanations.

A 32-year-old G3P2 at 30 weeks of gestation presents with sudden onset painless bright red vaginal bleeding. She has no uterine contractions and the fetal heart rate is normal. Ultrasound shows an anterior low-lying placenta completely covering the internal os. Which of the following is the MOST appropriate immediate management?
A 29-year-old G2P1 at 34 weeks presents with sudden onset severe constant abdominal pain and vaginal bleeding. The uterus is hard and tender. Fetal heart rate tracing shows a prolonged deceleration. Her blood pressure is 100/60 mmHg and she is tachycardic. Which is the MOST likely diagnosis?
A woman delivers a 3.8 kg baby vaginally and the placenta is delivered 5 minutes later. She develops bright red vaginal bleeding estimated at 700 mL. The uterus is soft and boggy on examination. Initial bimanual uterine massage is performed. Which is the FIRST-LINE uterotonic drug to be administered?
A 25-year-old primigravida had an uncomplicated vaginal delivery 12 days ago. She now presents with fever (38.8°C), foul-smelling lochia, and uterine subinvolution. On examination, the uterus is tender. Which of the following statements about the third stage of labour is MOST directly related to preventing this complication?
A G4P3 woman develops massive postpartum hemorrhage unresponsive to oxytocin, ergometrine, and carboprost. Examination of the genital tract reveals no lacerations. The uterus is atonic. Which surgical procedure is performed FIRST before proceeding to hysterectomy?
A patient at 30 weeks with a previous lower segment caesarean section presents with painless bright-red vaginal bleeding. Ultrasound shows anterior placenta praevia with loss of the clear zone between placenta and myometrium and multiple lacunae. The MOST likely diagnosis is:
A woman delivers vaginally and immediately afterwards develops PPH with a boggy uterus. She has received 10 IU oxytocin IV bolus and 0.2 mg ergometrine. Uterus is now atonic despite bimanual compression for 5 minutes. The NEXT drug of choice per WHO 2023 guidelines is:
A placenta praevia diagnosed at 20 weeks is most likely to resolve by term when it is:
A patient who underwent B-Lynch suture for PPH 6 months ago now presents with secondary amenorrhoea. HSG shows intrauterine adhesions. This complication is MOST directly attributable to:
A 28-year-old G2P1 at 36 weeks presents with sudden painless bright red vaginal bleeding. Ultrasound shows the placenta completely covering the internal os. Fetal heart rate is reactive. What is the MOST critical contraindication to management in this patient?
A multiparous patient undergoes cesarean section for placenta previa. During surgery, the placenta does not separate on its own and manual attempts at separation result in massive bleeding. MRI done antenatally had shown loss of the retroplacental clear zone. What is the MOST likely diagnosis and definitive management?
A woman delivers vaginally. At 20 minutes postpartum, the placenta has not been delivered. There is no active bleeding. What is the appropriate management sequence?
A 30-year-old woman develops massive PPH after a prolonged labour. Uterotonic agents and uterine massage have failed. Bimanual compression is being performed while surgical options are being considered. Which of the following B-Lynch suture technique descriptions is CORRECT?
A patient undergoes uterine balloon tamponade for atonic PPH following failed bimanual compression and oxytocin infusion. The balloon is inflated with 500 mL saline but bleeding continues. Which pharmacological agent should now be added, and what is its mechanism?
The WOMAN trial (World Maternal Antifibrinolytic Trial) demonstrated that tranexamic acid given within 3 hours of onset of PPH reduces death due to bleeding by what proportion, compared to placebo?
In placenta accreta spectrum (PAS) disorder, the pathological classification 'placenta increta' corresponds to which histological finding on uterine specimen?
A woman with previous two lower segment cesarean sections is found to have an anterior placenta previa at 28 weeks. MRI shows placental invasion into the bladder. What is the MOST appropriate intrapartum management strategy?
A G4P3 patient with prior three lower-segment cesarean sections is found to have placenta previa on second-trimester ultrasound. MRI shows loss of the hypointense interface between the placenta and myometrium with bulging into the bladder. What specific placentation abnormality and its sub-type does this describe?
A woman delivers a 4.2 kg baby after a prolonged second stage. One hour postpartum she has lost 900 mL blood. Uterine fundus is at the umbilicus and well-contracted. Placenta is confirmed complete. Laceration inspection reveals no cervical tear. BP is 90/60 mmHg. What is the most likely cause of hemorrhage and first-line specific intervention?
In management of massive postpartum hemorrhage unresponsive to uterotonics and bimanual compression, the B-Lynch compression suture is applied to the uterus. What is its anatomical mechanism of action?
A 28-year-old at 38 weeks with a marginal placenta previa is admitted for elective delivery planning. On admission she has painless bright red vaginal bleeding. Which description of placenta previa localisation best identifies the lesion as 'marginal'?
In the WOMAN trial (World Maternal Antifibrinolytic Trial), administration of tranexamic acid within 3 hours of PPH diagnosis reduced which specific outcome compared to placebo?
A patient with placenta previa accreta spectrum (PAS) undergoes cesarean delivery. Intraoperatively, the placenta does not separate spontaneously. The most appropriate surgical management to reduce maternal morbidity in a facility experienced with PAS surgery is:
Which of the following uterotonic agents acts via prostaglandin F2α receptors on uterine smooth muscle and is specifically contraindicated in asthma?
Vasa previa is associated with all of the following EXCEPT:
A 32-year-old G3P2 with two previous cesarean sections delivers at 38 weeks by repeat cesarean. The placenta fails to separate after 30 minutes of controlled cord traction. On attempting manual removal, the myometrium tears with the placenta. Histopathology of the excised uterus shows absence of the decidua basalis with chorionic villi directly adherent to myometrial fibers. What is this condition, and what is the classification?
A woman delivers vaginally and has PPH with estimated blood loss 1800 mL. She has received oxytocin 10 IU IM, misoprostol 800 mcg sublingual, and ergometrine 0.5 mg. Uterine tone is good. On examination, a 3 cm laceration of the posterior vaginal wall is identified but already repaired. BP is 80/50 mmHg and pulse 126/min. Despite all measures, bleeding continues from the uterine cavity. Thromboelastography (TEG) shows prolonged clot formation time (K time). What is the most appropriate next pharmacological intervention?
Vasa previa is associated with which placental anomaly that explains the underlying mechanism of fetal vessel rupture during membrane rupture?
A 29-year-old at 30 weeks presents with sudden onset painless vaginal bleeding of 200 mL. Ultrasound shows complete placenta previa. She is hemodynamically stable and the fetus is not in distress. What is the most appropriate management?
In the management of abnormally invasive placenta (placenta accreta spectrum), the 'conservative management' or 'leaving the placenta in situ' approach is most appropriate in which clinical scenario?
Uterine atony-related postpartum hemorrhage (PPH) not responding to oxytocin and misoprostol is being managed. The correct sequence of second-line uterotonic agents according to current WHO/FIGO guidelines is:
A patient undergoes Bakri balloon tamponade for PPH after vaginal delivery. After 24 hours, the balloon is deflated. The nurse reports 400 mL collected in the balloon drain over 24 hours during tamponade. This represents:
The Vasa previa type II (bilobed/succenturiate lobe placenta) is distinguished from type I by which characteristic?
The WOMAN trial (World Maternal Antifibrinolytic Trial) evaluated tranexamic acid in PPH. Its key finding regarding optimal timing of administration was that mortality benefit is seen only when tranexamic acid is given within:
A patient develops PPH unresponsive to oxytocin and methylergometrine. Carboprost (15-methyl PGF2α) is contraindicated. The second-line uterotonic of choice in a patient with asthma is:
In the management of morbidly adherent placenta (placenta accreta spectrum), the 'Triple-P procedure' involves occlusion of internal iliac arteries, perioperative imaging, and what third component?
In vasa previa Type II, the velamentous vessels traverse the cervical os crossing between the lobes of a bilobed placenta. The most sensitive prenatal diagnostic modality for vasa previa is:
In WOMAN trial (World Maternal Antifibrinolytic Trial), tranexamic acid for postpartum hemorrhage reduced death due to bleeding when administered within:
A patient with placenta accreta spectrum (PAS) disorder undergoes cesarean hysterectomy. Intraoperatively, bleeding is controlled with a balloon catheter in the internal iliac artery. The mechanism of hemostasis provided by this intervention is:
Morbidly adherent placenta with villi invading into but NOT through the myometrium is classified as:
A multiparous woman delivers vaginally, with an estimated blood loss of 700 mL and a firm uterus. Placenta is complete. Bleeding continues from the birth canal. The most likely cause is:
A 35-year-old woman with a previous classical cesarean section presents at 32 weeks with painless bright red vaginal bleeding. Ultrasound shows placenta previa with the placenta directly overlying the previous uterine scar. The MOST critical additional sonographic feature to assess, given the scar site, is:
In the management of atonic PPH not responding to oxytocin 40 units IV infusion and ergometrine 0.25 mg IM, the next pharmacological step according to WHO and FIGO guidelines is:
During management of a Grade III placenta previa cesarean section, the placenta is manually removed and there is persistent bleeding from the lower uterine segment. After bilateral uterine artery ligation fails to control hemorrhage, the surgical step that specifically addresses lower segment bleeding by reducing pulse pressure in the uterine circulation is:
A woman undergoes emergency peripartum hysterectomy for placenta percreta. Intraoperatively, massive hemorrhage occurs requiring 12 units packed RBCs, 10 units FFP, and 2 pools of platelets. She develops a worsening coagulopathy with fibrinogen 0.8 g/L and aPTT >100 sec. The intervention with the strongest Level 1 evidence to correct this acute hypofibrinogenemia is:
In the E-MOTIVE trial (2023, Lancet), a bundle intervention for postpartum haemorrhage (PPH) was tested against standard care. The bundle comprised uterine massage, oxytocin, tranexamic acid, examine and treat, and calling for help (if needed). The primary outcome (severe PPH defined as blood loss ≥1 litre) was significantly reduced. What is the mechanism by which tranexamic acid reduces blood loss in PPH when administered within 3 hours of delivery?
A patient with grade IV placenta praevia and a previous caesarean section is found on MRI to have placenta increta involving the posterior bladder wall. According to the FIGO 2018 classification of abnormally invasive placenta (AIP), which finding most specifically indicates placenta percreta?
A G3P2 woman delivers at 38 weeks and develops PPH due to uterine atony not responding to oxytocin and methylergometrine. Carboprost (15-methyl PGF2α) is being considered. Which of the following is the most important contraindication to carboprost in this scenario?
In women with vasa praevia type II (associated with a succenturiate lobe), at what gestational age does the Society for Maternal-Fetal Medicine (SMFM) 2020 recommend elective caesarean delivery in the absence of bleeding?
A woman with a previous caesarean scar at 32 weeks has placenta praevia with suspected accreta spectrum. MRI is performed. Which MRI feature carries the highest specificity for placenta percreta (invasion through serosa)?
During a caesarean section for placenta accreta spectrum, after delivery of the baby, the placenta is intentionally left in situ (conservative management). Which of the following is the recommended first-line post-operative pharmacological adjunct in this approach?
In the management of atonic primary postpartum hemorrhage unresponsive to oxytocin and ergometrine, tranexamic acid is administered. The WOMAN trial (2017) evaluated its use. Which of the following accurately reflects the trial's primary finding?
A woman develops secondary PPH 12 days postpartum with subinvoluted uterus and retained placental tissue confirmed on ultrasound. Her hCG is persistently elevated at 620 mIU/mL. Which additional investigation is mandatory before proceeding to curettage?
A 38-year-old grand multipara (G5P4) with a previous cesarean section delivers a placenta that fails to separate after 30 minutes of active management. Ultrasound reveals myometrial thinning with lacunae. She is taken to the operating room and found to have a placenta increta. According to the FIGO classification of abnormally invasive placenta, which placenta accreta spectrum (PAS) grade correlates with invasion into but not through the myometrium?
In the WOMAN trial (2017), tranexamic acid given within 3 hours of PPH onset was shown to reduce which specific outcome in women with postpartum hemorrhage?
A 30-year-old woman at 32 weeks gestation presents with painless bright red bleeding. She is hemodynamically stable. Transabdominal ultrasound reveals the placenta is covering the internal os. Which MRI feature would most strongly predict the need for cesarean hysterectomy in this patient if PAS is also suspected?
A 29-year-old G3P2 with two prior uterine surgeries delivers by cesarean section at 38 weeks. Intraoperatively, the placenta fails to separate and focal invasion of myometrium is confirmed histologically without bladder involvement. What is the histopathological diagnosis and what distinguishes it from a more advanced form?
The WOMAN trial (Lancet 2017) evaluated tranexamic acid (TXA) in PPH. Which of the following best summarizes its primary finding?
In the management of vasa praevia, which specific Doppler finding on second-trimester ultrasound most reliably identifies the condition?
A 30-year-old woman with two prior caesarean sections delivers at 38 weeks. On manual placenta removal, a portion of placenta is found adherent and cannot be separated. On histology, chorionic villi are found invading through the decidua and the full myometrium reaching the uterine serosa. This represents which grade of morbidly adherent placenta?
The WOMAN trial (2017) evaluated tranexamic acid in postpartum haemorrhage. Which of the following best summarises its key finding regarding mortality from PPH?
A 38-year-old grand multipara (G6P5) delivers vaginally. She receives 10 units oxytocin IM. After 30 minutes, the placenta has not delivered. Gentle cord traction fails. Bimanual examination reveals no uterine contractions. She has lost 600 mL so far. Which is the MOST appropriate next step according to current international guidelines?
The Kleihauer-Betke test in a Rh-negative mother after delivery detects fetal cells occupying 0.5% of the maternal red cell population. The maternal blood volume is approximately 5000 mL with a haematocrit of 36%. How many vials of anti-D immunoglobulin (standard dose 300 mcg each) are required to cover this fetomaternal haemorrhage?
The Confidential Enquiry into Maternal Deaths (UK) identified 'Four Ts' as the classification of postpartum hemorrhage aetiology. In a patient who delivered vaginally 30 minutes ago with 1200 mL blood loss, a firm uterine fundus, no cervical/vaginal lacerations, but with coagulopathy (INR 2.8, fibrinogen 80 mg/dL), the most likely aetiology is:
In the WOMAN trial (World Maternal Antifibrinolytic Trial), tranexamic acid administered within 3 hours of PPH onset significantly reduced which outcome?
Velamentous cord insertion with vasa praevia most commonly occurs in which placental configuration and why does it carry a particularly high fetal mortality risk?
In the management of morbidly adherent placenta (MAP — accreta spectrum), which surgical approach is associated with the lowest maternal blood loss and best outcomes according to current evidence?
A woman with a previous cesarean section has a low-lying anterior placenta at 20 weeks ultrasound. At delivery (36 weeks), placenta is found to be morbidly adherent. Which sonographic feature in the third trimester BEST predicts placenta percreta specifically (invasion into adjacent organs)?
The WOMAN trial (World Maternal Antifibrinolytic Trial) evaluated tranexamic acid (TXA) in postpartum hemorrhage. Which statement correctly reflects its key finding?
A G3P2 woman delivers by SVD. Uterus is well contracted after oxytocin, placenta is complete, but vaginal bleeding continues at 700 mL. On examination, cervical lacerations are not visible. Continued bright red bleeding with clots suggests which cause?
In vasa previa type II, what is the underlying anatomical basis that distinguishes it from type I?
A G3P2 woman delivers a healthy neonate. After placental delivery, the uterus fails to contract despite oxytocin 10 IU IM. Bimanual compression and methylergometrine are given with partial response. Bleeding continues at 1500 mL. What is the MOST appropriate next pharmacological agent according to WHO recommendations for atonic PPH refractory to first-line uterotonics?
A woman with placenta previa and three prior cesarean sections has ultrasound showing placental tissue invading through the myometrium into the bladder. The FIGO classification grade of placenta accreta spectrum (PAS) disorder in this case is:
In a postpartum patient with massive hemorrhage, an O-negative crossmatch-incompatible transfusion must be initiated urgently. After giving 6 units PRBC, 4 units FFP, and 1 unit of apheresis platelets, the patient still has uncontrolled ooze from wound edges. Which coagulation derangement is MOST likely responsible for this ongoing microvascular bleeding?
A woman with a documented type IV vasa previa on antenatal ultrasound is scheduled for cesarean delivery. The SMFM definition of vasa previa type II specifically refers to:
A 28-year-old G2P1 at 34 weeks presents with sudden painless bright red vaginal bleeding. Ultrasound shows a complete placenta previa. There is no uterine tenderness and fetal heart rate is 145 bpm. The most appropriate immediate management is:
A 35-year-old G4P3 undergoes cesarean section for complete placenta previa. At delivery, the placenta is found to be densely adherent and cannot be removed. Intraoperative blood loss is 2.8 L. Hysterectomy is performed. Histopathology of the uterus most likely shows:
A 30-year-old delivers vaginally after a prolonged third stage. Post-delivery blood loss is 650 mL and bleeding continues. Bimanual massage is performed, syntocinon is given, but bleeding persists. The uterus is well-contracted. The next step in management is:
A Rh-negative mother delivers a Rh-positive infant. Kleihauer-Betke test on maternal blood shows 0.6% fetal cells (maternal blood volume = 5000 mL). The estimated volume of fetomaternal hemorrhage (FMH) and the minimum dose of anti-D immunoglobulin required are:
A 38-year-old G5P4 develops sudden severe abdominal pain with fetal bradycardia at 39 weeks. She is in active labour. Her previous deliveries included two lower segment cesarean sections. Examination reveals a patulous uterine incision scar palpable vaginally. What is the most likely diagnosis?
A woman with a previous uterine scar delivers by repeat caesarean. The placenta is adherent and cannot be separated. Intraoperative blood loss reaches 2.5 litres. On pathology the villi invade but do NOT penetrate through the uterine serosa. The FIGO 2018 classification for this placentation abnormality is:
After a normal vaginal delivery, a primipara develops PPH. Uterine massage, IV oxytocin 20 units, and IM carboprost have been given. Bleeding continues. Bimanual compression is being maintained. The NEXT pharmacological agent of choice per WHO 2023 PPH guidelines is:
A Rh-negative woman has an antepartum haemorrhage at 32 weeks. Kleihauer-Betke test shows 1.2% fetal cells in maternal circulation. Using the standard formula (maternal blood volume = 5000 mL), the estimated fetomaternal haemorrhage (FMH) and the required anti-D dose (300 mcg per 30 mL fetal blood) are:
The WOMAN trial demonstrated that administering tranexamic acid within how many hours of PPH onset provided significant reduction in death due to bleeding?
A woman delivered vaginally 30 minutes ago and has now bled 1200 mL. Uterine massage and oxytocin infusion have been given. The uterus is firm. What is the MOST likely cause of postpartum hemorrhage?
A Rh-negative woman had a 20-week fetal demise. A Kleihauer-Betke test reveals 2.0% fetal cells in maternal circulation. How many 300 µg vials of anti-D immunoglobulin should she receive?
Which uterotonics combination is recommended as SECOND-LINE treatment for uterine atony unresponsive to oxytocin, according to WHO PPH guidelines?
In placenta accreta spectrum (PAS) disorder, which histological variant is characterised by chorionic villi invading into the myometrium but NOT penetrating it fully?
A 32-year-old G3P2 with two previous cesarean sections presents at 28 weeks with painless vaginal bleeding. Ultrasound reveals a posterior placenta previa with the placenta extending into the anterior uterine wall scar. MRI shows loss of the normal retroplacental clear zone with irregular lacunae. The most likely diagnosis and the most feared surgical complication are:
After an uncomplicated vaginal delivery, a woman has an estimated blood loss of 900 mL over 30 minutes. The uterus is well-contracted, the placenta delivered completely, and there is no perineal or cervical laceration. The next most appropriate step is:
Vasa previa is diagnosed antenatally by Doppler demonstrating fetal vessels crossing the internal os. At what gestational age is planned cesarean delivery recommended for vasa previa to optimally balance fetal lung maturity versus risk of hemorrhage?
A G2P1 at 38 weeks undergoes elective repeat cesarean section. During surgery, profuse hemorrhage occurs from the placental bed after delivery of a morbidly adherent placenta. Despite oxytocin, misoprostol, carboprost, and uterine compression sutures, bleeding persists. The internal iliac arteries are ligated bilaterally. The mechanism by which bilateral internal iliac artery ligation reduces uterine hemorrhage is:
A patient delivers vaginally and has an estimated blood loss of 800 mL. Uterine massage is performed and 10 units of syntocinon are given IM, but the uterus remains atonic. The next drug of choice to administer is:
The WOMAN trial demonstrated that tranexamic acid given within 3 hours of postpartum haemorrhage diagnosis significantly reduced which outcome?
Massive APH is managed with emergency caesarean section. Intraoperatively, despite oxytocics and bilateral uterine artery ligation, torrential bleeding continues. The next surgical step before proceeding to hysterectomy is:
A woman with placenta praevia major (Type IV) undergoes caesarean at 37 weeks. Histology confirms placenta accreta spectrum. Which FIGO grading of placenta accreta spectrum indicates myometrial invasion but without reaching the serosa?
A woman with vasa praevia type II presents at 32 weeks with painless vaginal bleeding after rupture of membranes. Fetal heart rate shows sinusoidal pattern. What is the most important diagnostic test that should have been used antenatally to identify this condition?
A 30-year-old G3P2 at 28 weeks with a previous classical cesarean section presents with painless bright-red antepartum bleeding. Ultrasound shows placenta anterior and covering the internal os with absence of the normal retroplacental clear space. What is the MOST likely diagnosis?
A 26-year-old primipara delivers a 3.8 kg baby. After active management of the third stage, 900 mL blood loss occurs with a soft uterus. Two doses of oxytocin IM and one dose of ergometrine have been given. The NEXT step in the medical management of this atonic PPH should be:
A patient undergoes B-Lynch suture for atonic PPH unresponsive to uterotonics. Which uterine artery ligation technique, when combined with internal iliac artery ligation, is described as the 'stepwise devascularisation' approach credited to O'Leary?
In the context of postpartum hemorrhage, the WOMAN trial (2017) tested which intervention and found what primary outcome benefit?
A woman delivers vaginally at term and has a PPH of 900 mL. Uterus is well contracted. Placenta is delivered complete. Perineal inspection shows a cervical laceration extending to the lower uterine segment. Despite primary repair the bleeding continues. What is the NEXT most appropriate step?
The WOMAN trial assessed tranexamic acid administration for PPH. Which of the following best describes the trial's main finding regarding mortality?
A woman in her second trimester presents with painless vaginal bleeding. Ultrasound shows the placenta completely covering the internal os. She is haemodynamically stable. Which examination is ABSOLUTELY CONTRAINDICATED?
A 34-year-old woman with two previous cesarean sections undergoes elective repeat cesarean at 37+6 weeks. Intraoperatively the placenta is found to be deeply invading the myometrium with no visible cleavage plane. The most appropriate management is:
A 28-year-old G3P2 with two prior cesarean sections undergoes ultrasound at 24 weeks. The placenta is anterior and low-lying. Color Doppler shows lacunae and loss of retroplacental clear zone. The MOST specific ultrasound feature that predicts placenta percreta (invasion through serosa) rather than accreta is:
A woman delivers vaginally at term. At 20 minutes, the placenta has not delivered. The uterus is contracted and the cord has lengthened. On gentle fundal pressure, blood wells up around the placenta. Oxytocin 10 IU was given IM at delivery. What is the next immediate management step?
A 30-year-old G1P0 undergoes cesarean section for fetal distress at 38 weeks. Her pre-operative Hb is 11 g/dL. She has no risk factors for PPH. According to WHO 2023 recommendations, the preferred uterotonic for prevention of PPH at cesarean section is:
A G3P2 at 32 weeks with two prior uterine surgeries presents with painless bright-red bleeding. Ultrasound reveals placenta previa with the placenta appearing to invade through the uterine serosa into the bladder. The FIGO 2019 classification for this placental invasion grade is:
The WOMAN trial (2017, Lancet) evaluating tranexamic acid in postpartum hemorrhage found that early administration (within 3 hours of delivery):
A woman develops massive PPH unresponsive to oxytocin, ergometrine, carboprost, and misoprostol. B-Lynch suture is applied but bleeding persists. The NEXT step in the surgical management algorithm before proceeding to hysterectomy is:
A woman at 36 weeks with a suspected placenta previa major undergoes colour Doppler ultrasound. Turbulent subplacental lacunar flow with multiple venous lakes and loss of the hypoechoic retroplacental zone on B-mode are noted. These findings are most consistent with:
Uterine rupture complicating labour is most commonly associated with which risk factor, and what is the classic clinical sign of impending rupture?
The WOMAN trial (2017) established the benefit of tranexamic acid in postpartum haemorrhage. What was its primary finding regarding mortality?
Placenta accreta spectrum (PAS) is classified by depth of invasion. Which FIGO 2018 classification grade corresponds to placenta percreta with invasion of the bladder wall?
A 32-year-old G3P2 with previous two caesarean sections presents with painless antepartum haemorrhage at 34 weeks. Ultrasound confirms complete placenta praevia with a retroplacental echolucent zone and multiple intraplacental lacunae. The MOST important immediate next investigation is:
In Couvelaire uterus (uteroplacental apoplexy) complicating severe placental abruption, the management includes all of the following EXCEPT:
A patient at 32 weeks with a previous uterine scar presents with a low-lying anterior placenta on ultrasound. MRI confirms loss of the normal retroplacental clear space with placental tissue extending into the myometrium but not beyond the serosa. The most accurate diagnosis is:
In the WOMAN trial, which intervention was shown to reduce mortality from postpartum hemorrhage when given within 3 hours of delivery?
A patient with massive PPH unresponsive to oxytocin, ergometrine, and carboprost undergoes B-Lynch suture. The suture compresses the uterus by which mechanism?
A woman delivers vaginally after oxytocin augmentation. Thirty minutes post-delivery, the uterus is boggy, there is active vaginal bleeding 800 mL, BP 90/60 mmHg, and the placenta has been delivered intact. After bimanual compression and IV oxytocin 20 units infusion, bleeding continues. Which is the NEXT most appropriate uterotonic?
Regarding vasa previa, which of the following best describes Type II vasa previa?
The WOMAN trial evaluated tranexamic acid in PPH. Which was the primary finding regarding mortality benefit?
A 32-year-old G3P2 with two previous uterine surgeries undergoes ultrasound at 18 weeks. The placenta is anterior, covering the internal os, with loss of the retroplacental clear zone and multiple vascular lacunae. The most appropriate next investigation to evaluate depth of invasion is:
Regarding placenta praevia, which classical symptom complex distinguishes it from placental abruption?
Uterine balloon tamponade (Bakri balloon) is used in the management of atonic PPH refractory to uterotonics. The 'tamponade test' is considered positive when:
A woman with prior uterine surgery undergoes ultrasound at 20 weeks which shows placenta previa with irregular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and Doppler showing turbulent lacunar flow. What is the MOST LIKELY diagnosis?
A woman delivers vaginally and has 1200 mL blood loss. The uterus is soft, central, and atonic on examination. Oxytocin 10 units IV has been given. What is the NEXT appropriate uterotonic to administer for medical management of uterine atony?
The B-Lynch suture for postpartum hemorrhage works by which mechanism?
The WOMAN trial (2017) demonstrated that tranexamic acid for primary postpartum hemorrhage reduces death from bleeding if given within which time window of PPH onset?
A 32-year-old G3P2 with two prior caesarean sections undergoes ultrasound at 20 weeks. The placenta is anterior, low-lying, and loss of the retroplacental clear zone is noted on Doppler. The most likely diagnosis and the investigation of choice to confirm placental invasion depth are:
The WOMAN trial (World Maternal Antifibrinolytic Trial) demonstrated that tranexamic acid administered within how many hours of PPH onset significantly reduces death from bleeding?
A woman delivers vaginally and 20 minutes later develops brisk vaginal bleeding. The uterus is firm and well-contracted on palpation. Placenta has been delivered completely. The most likely cause of her haemorrhage is:
Which uterine compression suture was described for management of PPH specifically targeting lower uterine segment bleeding (e.g., placenta praevia/accreta), distinct from the B-Lynch suture?
Placenta accreta spectrum (PAS) is classified by the depth of invasion. In which type does the placenta invade through the full thickness of the myometrium and into the serosa, but NOT the adjacent pelvic organs?
A woman delivers a live term infant and 45 minutes later has an atonic uterus despite active management of the third stage. Oxytocin infusion has been running. The WOMAN trial showed that tranexamic acid given within 3 hours of PPH significantly reduced:
On ultrasound, a central placenta praevia is noted at 20 weeks in a woman with a previous lower-segment caesarean section. The single most important sonographic predictor of placenta accreta spectrum in this scenario is:
A primigravida at 36 weeks presents with sudden painless bright red bleeding, no uterine contractions, and a soft non-tender uterus. Fetal heart rate is normal. The most appropriate immediate investigation is:
A 34-year-old woman with two previous cesarean sections undergoes ultrasound at 20 weeks. The placenta is anterior and covers the internal os; there is loss of the retroplacental clear zone and multiple lacunae with turbulent flow on color Doppler. The MOST likely diagnosis is:
The WOMAN trial evaluated the use of tranexamic acid in postpartum hemorrhage. The key finding of this trial was:
A woman delivers vaginally and develops PPH due to uterine atony. Oxytocin, ergometrine, and misoprostol have been given. Uterine massage is ongoing. The NEXT pharmacological agent to be used according to current WHO guidelines is:
A woman develops massive obstetric hemorrhage requiring massive transfusion protocol. The OPTIMAL ratio of packed red blood cells to fresh frozen plasma to platelets in damage-control resuscitation is:
A 30-year-old woman at 34 weeks has painless antepartum hemorrhage. Ultrasound shows a low-lying posterior placenta with the placental edge 1.5 cm from the internal os. She has stopped bleeding and is hemodynamically stable. The MOST appropriate management plan is:
A woman develops PPH after vaginal delivery. Despite uterotonics, she continues to bleed. Surgical options are escalated. The B-Lynch suture compresses the uterus by which mechanism?
A woman with placenta previa totalis undergoes cesarean at 37 weeks. After delivery of the placenta the uterus fails to contract. Oxytocin infusion, ergometrine, and carboprost have been administered. Bleeding continues at 1.2 L. What is the next surgical step before hysterectomy?
In the WOMAN trial, which drug was shown to reduce mortality from postpartum hemorrhage when given within 3 hours of birth?
Placenta accreta spectrum is classified into three types. Which histological finding distinguishes placenta increta from placenta accreta?
A G3P2 woman at 32 weeks presents with painless, bright red vaginal bleeding. Ultrasound confirms placenta previa. She is hemodynamically stable with a fetal heart rate of 148 bpm. What is the most appropriate immediate management?
Couvelaire uterus (uteroplacental apoplexy) is most specifically associated with which complication of pregnancy?
A 35-year-old woman with two previous cesarean sections undergoes ultrasound at 20 weeks. The placenta is anterior, low-lying, and Doppler shows loss of retroplacental clear space with intraplacental lacunae and hypervascularity of the bladder–uterine interface. The MOST likely diagnosis and its sub-type is:
The WOMAN trial (2017) evaluated tranexamic acid (TXA) in postpartum haemorrhage. Which conclusion is MOST accurate based on its findings?
A 30-year-old G3P2 delivers vaginally and has an estimated blood loss of 900 mL. The uterus is well contracted. Placenta is delivered whole. Perineal tear repair is complete. Persistent brisk bleeding continues from the vaginal vault. The NEXT step is:
Carbetocin is preferred over oxytocin for prevention of PPH at cesarean section in high-income settings primarily because:
In placenta praevia, which combination of ultrasound findings predicts the HIGHEST likelihood of requiring cesarean hysterectomy for placenta accreta spectrum?
The World Maternal Antifibrinolytic (WOMAN) trial evaluated tranexamic acid in PPH. Which was the KEY finding regarding death from bleeding?
A 26-year-old primigravida with vasa praevia (type I — vessels crossing the internal os) is diagnosed antenatally on transvaginal Doppler ultrasound at 22 weeks. The recommended management plan is:
In the management of massive postpartum haemorrhage (PPH) unresponsive to first-line uterotonics (oxytocin, ergometrine, carboprost), the next surgical option before proceeding to hysterectomy is B-Lynch suture. The B-Lynch suture compresses the uterus by:
Vasa previa is most reliably diagnosed by which investigation, and what is the risk to the fetus if it is undiagnosed?
In a case of placenta previa totalis at 34 weeks with a single episode of painless bleeding that resolved spontaneously, maternal vitals stable and fetal CTG normal, what is the MOST appropriate management?
A woman presents at 35 weeks with painless bright red vaginal bleeding immediately following spontaneous rupture of membranes, accompanied by acute fetal bradycardia. The Apt test is positive. What is the MOST likely diagnosis and the immediate management?

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