Postpartum haemorrhage: bimanual compression: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Postpartum haemorrhage: bimanual compression

Sample item

A woman has atonic PPH of 1000 mL with a soft, boggy uterus, and uterine massage and oxytocin are in progress. While awaiting further drugs, which first-aid manoeuvre can control bleeding?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Bimanual uterine compression with one fist in the anterior vaginal fornix and the other hand behind the fundus

In bimanual compression, one hand in the vagina compresses the anterior wall of the uterus while the other hand on the abdomen compresses the posterior wall, mechanically squeezing the uterus and kinking the uterine vessels. It is a temporising measure used with uterotonics, fluids and preparation for more definitive steps. Aortic compression is another first-aid manoeuvre.

Option by option

  • A. Bimanual uterine compression with one fist in the anterior vaginal fornix and the other hand behind the fundus (correct)

    Correct. Bimanual compression provides immediate mechanical control while drugs take effect.

  • B. Digital removal of the cervix

    There is no such manoeuvre as removal of the cervix.

  • C. Ligating the internal iliac arteries at the bedside

    Iliac ligation is a surgical procedure, not bedside first aid.

  • D. Packing the vagina tightly with gauze

    Vaginal packing conceals bleeding and does not make the uterus contract.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Bimanual uterine compression with one fist in the anterior vaginal fornix and the other hand behind the fundus. In bimanual compression, one hand in the vagina compresses the anterior wall of the uterus while the other hand on the abdomen compresses the posterior wall, mechanically squeezing the uterus and kinking the uterine vessels.

Why is "Digital removal of the cervix" not the answer?

There is no such manoeuvre as removal of the cervix.

Why is "Ligating the internal iliac arteries at the bedside" not the answer?

Iliac ligation is a surgical procedure, not bedside first aid.

Why is "Packing the vagina tightly with gauze" not the answer?

Vaginal packing conceals bleeding and does not make the uterus contract.

What concept does this question test?

It tests Postpartum haemorrhage: bimanual compression in OBG. It is a temporising measure used with uterotonics, fluids and preparation for more definitive steps. Aortic compression is another first-aid manoeuvre.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Postpartum haemorrhage: bimanual compression?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.