Медведєв Михайло ВолодимировичТестуванняObstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Медведєв Михайло Володимирович // 24 Сентября 2017

Вопросов в тесте: 20

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Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Patient 25 years old entered maternity hospital in 38 weeks of pregnancy with regular uterine contractions and bloody discgarge from vagina. The uterine cervix is effaced, opening of canal 4 cm and is blocked by spongy tissue of soft consistency. During bimanual exam bleeding was increased. What is the reason of increasing of bleeding?

вопрос 1 из 20 //

Варианты ответа:

  1. Unknown reason
  2. Abruptio placentae
  3. Complete placenta previa
  4. The coagulopathic bleeding
  5. Bleeding from the rupture of uterine cervix
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Patient is delivered by the ambulance with complaints of acute pain in lower part of abdomen, which appeared suddenly after falling, dizziness, bloody discharge from vagina; term of pregnancy – 39 weeks. Uterine contractions are regular, every 5 minutes last 40 seconds, amniotic fluid did not released. Objectively: skin and visible mucus membranes are pale, BP 80/50 mm Hg, PR – 126 bpm. Uterus is tense, on the left near a fundus lump is determined, this area is painful at palpation. Fetal heart rate – 170, arhytmic. At vaginal examination: the uterine cervix is effaced, opening of uterine cervix is 5 cm, amniotic membranes are present, parts of placenta are not determined, head of the fetus is above the pelvic inlet. Discharge is bloody, without clots. Test of Lee-White is 15 min. Diagnosed premature separation of normally located placenta. What is the most possible complication?

вопрос 2 из 20 //

Варианты ответа:

  1. Development of DIC-syndrome
  2. Uterine rupture
  3. Uterine tetanus
  4. Dyscoordinated uterine contractions
  5. Hypotonic uterine bleeding
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Multipara. Uterine contractions last 4-5 hours. Bloody excretions began at once after beginning of contractions. Fetal heart rate is 100-110 in min. Vaginal examination: the uterine cervix is effaced, edges 0,3 cm, soft. The cervical canal is opened up to 6 cm. In the cervix placental tissue is determined. Diagnosis?

вопрос 3 из 20 //

Варианты ответа:

  1. Abruptio placentae
  2. Threatened rupture of uterus
  3. Cervical laceraation
  4. Central placenta previa
  5. Normal cource of labor
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

The 26-year old woman had the second for the last 2 years labor with oxytocin application. The child’s weight is 4080 g. After the placental birth there was a severe bleeding, signs of hemorrhagic shock. Despite the introduction of contractive agents, good contraction of the uterus and absence of any uterus, cervix and the vagina injuries, the bleeding proceeds. Choose the most probable cause of bleeding.

вопрос 4 из 20 //

Варианты ответа:

  1. Atony of the uterus
  2. Hypotony of the uterus
  3. Delay of the part of placenta in uterine cavity
  4. DIC
  5. Uterine rupture
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

The bleeding began right after childbirth. The blood loss is 350 ml. Signs of the placental separation are negarive. What is the most appropriate management?

вопрос 5 из 20 //

Варианты ответа:

  1. Total hysterectomy
  2. Uterine artery ligation
  3. Manual separation of placenta and exploration of the uterine cavity
  4. Prescription of contractile drugs
  5. Uterine curretage
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

On the 6 day of the postpartum period a 26 years-old woman complaints of profuse bleeding from vagina. Pelvic examination reveals 23-24 weeks increased uterus with clots inside. During examination bloody discharge increases. Diagnosis?

вопрос 6 из 20 //

Варианты ответа:

  1. Total placenta adherens
  2. Couveler’s uterus
  3. Late postpartum hemorrhage
  4. Subtotal placenta adherens
  5. Placenta previa
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

In postpartum patient the massive hypotonic uterine bleeding began after labor by dead child. The blood loss is achieved 1600 ml. From the uterus a liquid blood flows out. A blood from a vein does not coagulate. Quantity of trombocytes 80x109/l. The places of injections bleed. What stage of DIC-syndrome has developed in this patient?

вопрос 7 из 20 //

Варианты ответа:

  1. 4
  2. 5
  3. 1
  4. 2
  5. 3
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

A 32-years-old woman has massive bleeding after labor of twins. Placenta, vagina and perineum are without lacerations. Uterine fundus is higher than umbilicus, uterus at palpation is soft. Tone of uterus does not change after introduction of oxytocin. What reason of bleeding is most probable?

вопрос 8 из 20 //

Варианты ответа:

  1. Coagulopathy syndrome
  2. Uterine rupture
  3. Atony of uterus
  4. Hypotonic uterine contractions
  5. Placenta remnants
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

1. Postpartum patient 28 years. A girl was born with weight 3800 g., length 52 cm. Placenta was delivered in 15 minutes and 300 ml of blood was discharged. Bleeding is continuing. At the exam of cervix and vagina lacerations were not found. Placenta – ruptured vessels on the edge of membranes were found. What is the subsequent management?

вопрос 9 из 20 //

Варианты ответа:

  1. To conduct the external massage of uterus
  2. To conduct the tamponade of uterus
  3. To perform the manual examination of uterine cavity
  4. Total hysterectomy
  5. Uterotonics
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Woman D. labor begins in 39 weeks of pregnancy. In anamnesis there is artificial abortion, which was complicated by endometritis. During 40 min. the signs of placental separation are not present. The signs of the external and internal bleeding are absent. Considerable bloody discharge appeared after an attempt of the manual separation of placenta. The blood loss is 400 ml. The manual separation of placenta from the uterus was not successful. What is the doctor’s tactic?

вопрос 10 из 20 //

Варианты ответа:

  1. Curettage
  2. Subtotal hysterectomy
  3. Uterotonics
  4. Total hysterectomy
  5. Hemostatics
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

The bleeding began right after childbirth. The blood loss is 300 ml. There aren’t signs of the placental separation. What is the most probable diagnosis?

вопрос 11 из 20 //

Варианты ответа:

  1. Placenta abruption
  2. Couveler’s uterus
  3. Placenta previa
  4. Placenta increta
  5. Placenta accreta
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Patient is delivered to a clinic with complaints about abdominal pain, loss of consciousness. Term of pregnancy 40 weeks. BP – 80/60 mm Hg, pulse 126 per 1 min, weakness. Skin is pale. Uterus is dense, in right side marked protrusion is identified. At palpation this area is painful. Fetal heart rate is 160 per 1 min, arhythmical. From vagina blood in a small amount is discharged. Uterine contractions are moderate, amniotic membranes are intact. At vaginal examination: the opening of uterine cervix is 5-6 cm. Tissue of placenta is not palpated. Diagnosis?

вопрос 12 из 20 //

Варианты ответа:

  1. Placental abruption
  2. Preeclampsia
  3. Bleeding from the varicous veins of vagina
  4. Placenta previa
  5. Uterine rupture
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

A parturient woman aged 32. After 3d full term delivery (the fetal weigh is 4,3 kg) in early postpartum period bleeding was appeared. To stop it, the external massage of uterus, introduction of uterotonics, manual examination of uterine cavity were performed. The result was absent, bleeding continued, hemorrhage ran up to 1500 ml. Patient’s condition is severe: she is pale, heartbeat reaches 140 b/min, BP 80/40 mm Hg. What is the method of bleeding termination in this case

вопрос 13 из 20 //

Варианты ответа:

  1. To introduce the methylergometrin intravenously
  2. To repeat massage of the uterus
  3. To perform the tamponade of uterus
  4. To perform the clamping of the parametria by Henkel
  5. To perform laparotomy with hysterectomy without adnexa
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Patient F., 18 years old. Labor is first, at term. Mass of patient’s body is 100 kg. What volume of blood loss is possible and physiological?

вопрос 14 из 20 //

Варианты ответа:

  1. 1000 ml
  2. 700 ml
  3. 500 ml
  4. 1500 ml
  5. 800 ml
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of vaginal bleeding. In anamnesis there were two artificial abortions. In a period of 33 weeks there was noted the onset of hemorrhage and US showed a placenta previa. The uterus was in normal tonus, the fetus position was transverse. The fetal heartbeats are clear, rhythmical, 160 b/min. What is the best tactics of management of the woman

вопрос 15 из 20 //

Варианты ответа:

  1. To perform the observation for the intensity of hemorrhage and at the moment of stopping the bleeding to prolong the pregnancy
  2. To hospitalize and continue observation
  3. To perform the stimulation of delivery by intravenous introduction of oxytocin
  4. To perform the hemotransfusion and to prolong the pregnancy
  5. Cesarean section
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Multipara. Uterine contractions last 4-5 hours. Bloody excretions began at once after beginning of contractions. Fetal heart rate is 100-110 in min. Vaginal examination: the uterine cervix is effaced, edges 0,3 cm, soft. The cervical canal is opened up to 6 cm. In the cervix placental tissue is determined. The most correct management plan?

вопрос 16 из 20 //

Варианты ответа:

  1. Observation
  2. Addd oxytocin
  3. Vacuum-extraction of fetus
  4. Emergency Cesarean section
  5. Forceps delivery
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Nulliparous woman, 22 years old. Pregnancy 35-36 weeks. Sizes of pelvis: 25-26-31-20. Without uterine contractions, at night bleeding appeared from vagina in a quantity 80-100 ml. Fetal heart rate is clear, rhythmic, 136 per 1 min. At internal examination: the uterine cervix is shortened, a cervix passes over a 1 finger. In the cervix soft tissue is palpated. Head of the fetus is mobile above the pelvic inlet. During examination, bleeding increased. Define obstetric management

вопрос 17 из 20 //

Варианты ответа:

  1. Bed rest
  2. Cesarean section
  3. Strict bed rest and hemostatic therapy
  4. Forceps
  5. Amniotomy
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Multipara N. is in III stage of labor. The baby weight is 4500 g, length 56 cm. In 15 min. after the fetal delivery the bleeding began. General blood loss is now 1,5% from the woman’s body weight. What is the management?

вопрос 18 из 20 //

Варианты ответа:

  1. B-Lynch stitch
  2. Repeated manual revision of uterine cavity
  3. Total hysterectomy
  4. Observation
  5. Tamponade of uterine cavity
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

Postpartum patient 28 years old, pregnancy is sixth (4 abortions, 2 complicated with endometritis). Labor is second, first stage of labor was without complications, mass of fetus was 4500 g. Placenta separated and delivered in 7 min. after delivery of the fetus with all cotyledons. Blood lost was 350 ml. In 5 min. bloody discharge was increased, after external massage the uterus contracts for short time and again loses it’s tonus and becomes soft, bleeding proceeds. Diagnosis?

вопрос 19 из 20 //

Варианты ответа:

  1. Rupture of the cervix
  2. Uterine rupture
  3. Hypotonic bleeding
  4. Atonic bleeding
  5. Placental abruption
Obstetric hemorrhage during the second half of pregnancy, labor and postpartum period

1Patient is delivered with pregnancy at term with active uterine contractions. During hospitalization the condition is satisfactory, pulse - 84 in 1 min, BP - 150/90 and 160/90 mm of Hg. Suddenly patient complained on severe pain in abdomen, a general weakness, dizziness, face and lips became pale. Pulse - 120 in 1 min, BP - 80/40 and 90/45 mm of Hg. Uterus is dense, very painful. Fetal heart rate is not identified. At vaginal examination: the uterine cervix is effaced, opening 5 cm. Amniotic membranes are unruptured. The head is in the pelvic inlet. Insignificant bloody discharge from vagina. What is the most probable diagnosis?

вопрос 20 из 20 //

Варианты ответа:

  1. Uterine rupture
  2. Molar pregnancy
  3. Amniotic fluid embolism
  4. Placenta previa
  5. Placental abruption