Which is the high-risk factor for PPH, EXCEPT?

Appeared in: KGMU 2023

Explanation

Hyperemesis gravidarum is a condition of severe nausea and vomiting, primarily occurring in the first trimester of pregnancy.
It leads to complications like dehydration, electrolyte imbalance, and weight loss, but it does not directly affect the mechanisms of uterine contraction, placental separation, or blood coagulation at the time of delivery.
Therefore, it is not considered a direct high-risk factor for postpartum hemorrhage (PPH).

Option A: Pregnancy-Induced Hypertension (PIH) is a significant risk factor for PPH.
Option B: A twins pregnancy (multiple gestation) is a major risk factor for PPH.
Option D: A previous caesarean section is a well-established risk factor for PPH in subsequent pregnancies.

Visual 1: Infographic - The '4 Ts' of Postpartum Hemorrhage (Tone, Trauma, Tissue, Thrombin). This would visually categorize the causes of PPH, helping to link the risk factors in the options to their underlying mechanism.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risk factors for Postpartum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
Nurses must perform a thorough antenatal risk assessment for PPH for every pregnant woman. Identifying risk factors like multiple gestation, PIH, or prior C-section allows the healthcare team to prepare for potential complications during and after delivery.
This includes ensuring IV access, availability of blood products, and having uterotonic drugs readily available.
What if the patient had a prolonged labor augmented with oxytocin? This would also be a significant risk factor for PPH due to uterine muscle fatigue, falling under the 'Tone' category, further increasing the need for vigilant postpartum monitoring.

How to Approach the Question

First, identify the core concept of the question, which is risk factors for Postpartum Hemorrhage (PPH).
Note the keyword 'EXCEPT'. This means you are looking for the option that is NOT a risk factor.
Evaluate each option's relationship to PPH:
Does PIH increase bleeding risk? Yes, through abruption and coagulopathy.
Does a twins pregnancy increase bleeding risk? Yes, through uterine atony.
Does hyperemesis gravidarum affect bleeding after birth? No, it's an early pregnancy issue.

Concept Tested & Keywords

Concept Tested: Risk factors for Postpartum Hemorrhage (PPH)
Stem keywords: high-risk factor, PPH, Postpartum hemorrhage
Lead-in keywords: EXCEPT
Negative lead-in flag: Question asks for the exception, meaning three options are risk factors and one is not.

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Practise the full KGMU 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.