Which client is at greatest risk for early PPH?

Correct Answer: B

Rationale: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH

Correct Answer: B

Rationale: The most accurate statement regarding the basic definitions and incidence data of postpartum hemorrhage (PPH) is statement B. Traditionally, PPH is defined as losing more than 1000 ml of blood after vaginal birth and more than 2500 ml after cesarean birth. This definition helps healthcare providers recognize and diagnose PPH based on the amount of blood loss, which is crucial for prompt intervention and management.

Correct Answer: D

Rationale: Placenta abruptio, also known as abruptio placentae, is the premature separation of the placenta from the uterine wall before delivery. It is not classified as an abnormal adherence pattern like placenta accreta, increta, and percreta. Placenta accreta occurs when the placenta attaches too deeply into the uterine wall. Placenta increta is when the placenta invades the myometrium, and placenta percreta is when it penetrates through the myometrium and reaches the serosa. These abnormal adherence patterns are associated with risks and complications during pregnancy and delivery, while placenta abruptio is a separate condition related to premature placental separation.

Correct Answer: C

Rationale: Desmopressin (DDAVP) is the initial treatment for a client with von Willebrand disease (vWD) who experiences a postpartum hemorrhage (PPH). Desmopressin works by releasing von Willebrand factor (vWF) stored in the endothelial cells, increasing the levels of vWF and factor VIII. This can help improve clotting function in patients with vWD, thereby helping to stop the bleeding. It is a safe and effective treatment for many individuals with vWD and is often used as the first-line therapy in cases of bleeding episodes or surgeries. Cryoprecipitate may also be used in severe bleeding situations if desmopressin is ineffective. Hemabate is not indicated for the treatment of vWD and PPH.

Correct Answer: A

Rationale: Hysterectomy is a surgical procedure that involves the removal of the uterus. In cases where nonsurgical treatment for late postpartum hemorrhage (PPH) is ineffective, and the cause of the condition is related to the uterus (such as retained placental tissue, uterine atony, or placenta accreta), a hysterectomy may be necessary to stop the bleeding and correct the underlying issue. Hysterectomy is considered a definitive treatment for PPH when other interventions have failed to control the bleeding.