Postpartum haemorrhage and emergencies: vulval haematoma: 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: vulval haematoma

Sample item

Two hours after a vacuum delivery, a woman has severe perineal pain, cannot pass urine, and has a tense, bluish swelling of the left labium that is enlarging. Pulse is 112 per minute and haemoglobin is falling. What is the best management?

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

The answer and the reasoning

B. Resuscitate, then incise, evacuate the clot and ligate the bleeding vessel

A large, expanding vulval or paravaginal haematoma with pain, retention and haemodynamic change needs drainage. The clot is evacuated, the bleeding point is ligated, and the cavity is closed or packed. Small non-expanding haematomas can be managed conservatively.

Option by option

  • A. Apply ice packs and analgesia and observe

    Ice and observation suit only small, stable, non-expanding haematomas.

  • B. Resuscitate, then incise, evacuate the clot and ligate the bleeding vessel (correct)

    Correct. An expanding haematoma with shock needs resuscitation and surgical drainage with vessel ligation.

  • C. Start an oxytocin infusion to contract the uterus

    The uterus is not the source, so uterotonics will not control this bleeding.

  • D. Perform laparotomy with internal iliac artery ligation

    Laparotomy is for bleeding above the pelvic floor, not a vulval haematoma.

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 B, Resuscitate, then incise, evacuate the clot and ligate the bleeding vessel. A large, expanding vulval or paravaginal haematoma with pain, retention and haemodynamic change needs drainage.

Why is "Apply ice packs and analgesia and observe" not the answer?

Ice and observation suit only small, stable, non-expanding haematomas.

Why is "Start an oxytocin infusion to contract the uterus" not the answer?

The uterus is not the source, so uterotonics will not control this bleeding.

Why is "Perform laparotomy with internal iliac artery ligation" not the answer?

Laparotomy is for bleeding above the pelvic floor, not a vulval haematoma.

What concept does this question test?

It tests Postpartum haemorrhage and emergencies: vulval haematoma in OBG. The clot is evacuated, the bleeding point is ligated, and the cavity is closed or packed. Small non-expanding haematomas can be managed conservatively.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: vulval haematoma?

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.