Typical exam stem
A woman develops heavy vaginal bleeding immediately after delivery and becomes tachycardic. How would you manage the emergency?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What are the 4 Ts of postpartum haemorrhage?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Call for help and resuscitate immediately
Postpartum haemorrhage can progress rapidly. Activate the obstetric haemorrhage response, assess airway and breathing, obtain large-bore intravenous access, send blood for full blood count, coagulation studies and cross-match, and begin haemodynamic resuscitation while the cause is identified. Quantify blood loss as accurately as possible and monitor response rather than relying on visual estimation alone.
Use the 4 Ts
- Tone: uterine atony is common; assess uterine tone and begin uterine massage and uterotonic treatment according to protocol.
- Trauma: inspect for genital tract tears, uterine rupture or inversion.
- Tissue: assess for retained placenta or products of conception.
- Thrombin: consider coagulopathy, especially with massive bleeding, abruption, sepsis or prolonged obstetric complications.
Escalation
Use tranexamic acid early when indicated and continue cause-specific treatment. If bleeding persists, escalate promptly to balloon tamponade, interventional radiology or surgery according to cause, severity and available resources. Massive transfusion protocols may be required. Delay in escalation is a major preventable danger in ongoing haemorrhage.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.