Postpartum haemorrhage and emergencies: bleeding with a firm uterus: 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 and emergencies: bleeding with a firm uterus

Sample item

Fifteen minutes after a forceps delivery, a woman has continuous bright red bleeding. The fundus is firm and well contracted, and the placenta and membranes are complete. What is the next step?

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

The answer and the reasoning

C. Examine the cervix, vagina and perineum for tears in good light

Continuous bleeding from a firmly contracted uterus after an instrumental delivery points to genital tract trauma, the trauma cause among the four Ts. The lower genital tract and cervix should be inspected systematically and the tears sutured.

Option by option

  • A. Apply bimanual uterine compression

    Bimanual compression treats an atonic, boggy uterus.

  • B. Perform manual removal of the placenta

    The placenta is already complete, so manual removal has no role.

  • C. Examine the cervix, vagina and perineum for tears in good light (correct)

    Correct. A firm uterus with continuous bright bleeding calls for a search for lacerations.

  • D. Start intravenous carboprost for uterine atony

    Carboprost treats atony, which is not present with a firm fundus.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Examine the cervix, vagina and perineum for tears in good light. Continuous bleeding from a firmly contracted uterus after an instrumental delivery points to genital tract trauma, the trauma cause among the four Ts.

Why is "Apply bimanual uterine compression" not the answer?

Bimanual compression treats an atonic, boggy uterus.

Why is "Perform manual removal of the placenta" not the answer?

The placenta is already complete, so manual removal has no role.

Why is "Start intravenous carboprost for uterine atony" not the answer?

Carboprost treats atony, which is not present with a firm fundus.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: bleeding with a firm uterus in OBG. The lower genital tract and cervix should be inspected systematically and the tears sutured.

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 and emergencies: bleeding with a firm uterus?

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.