Which of the following are risk factors for postpartum hemorrhage (PPH)?& x20; - NORCET 9 Mains - 2025

NORCET 9 Mains - 2025

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 9 Mains - 2025

Explanation

Twin pregnancy is a major risk factor for postpartum hemorrhage (PPH).
The presence of two fetuses causes significant overstretching (overdistension) of the uterine muscle fibers.
After delivery, these overstretched muscles have difficulty contracting effectively, a condition known as uterine atony.
Uterine atony is the most common cause of PPH, as the failure to contract prevents compression of blood vessels at the placental site, leading to severe bleeding.
This risk factor falls under the 'Tone' category in the '4 T's' mnemonic for PPH causes.

Option B: While gestational hypertension, and particularly its severe form, preeclampsia, is a risk factor for PPH, it is generally considered less direct than twin pregnancy. Its association with PPH is often due to related coagulopathies (a 'Thrombin' issue) or as a side effect of magnesium sulfate treatment, which can relax the uterus and contribute to atony.
Option C: Hyperemesis gravidarum (severe nausea and vomiting in pregnancy) is not recognized as a direct risk factor for postpartum hemorrhage. It primarily causes dehydration, malnutrition, and electrolyte imbalances.
Option D: Oligohydramnios is a condition of having too little amniotic fluid. This does not cause uterine overdistension and therefore is not a risk factor for uterine atony or PPH.

Visual 1: Infographic - The '4 T's' of Postpartum Hemorrhage (Tone, Trauma, Tissue, Thrombin), illustrating each category with clear icons and examples. For 'Tone', an overdistended uterus from twins should be shown.

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 play a critical role in identifying patients at high risk for PPH before delivery. A history of twin pregnancy is a major red flag.
For high-risk patients, proactive measures should be taken, such as ensuring patent IV access with a large-bore catheter, having uterotonic medications readily available, and potentially cross-matching blood in advance.
Vigilant postpartum assessment of uterine tone (fundal massage), vital signs, and the amount of lochia is crucial for early detection and management of PPH.

How to Approach the Question

First, identify the key concept in the question, which is 'risk factors for postpartum hemorrhage (PPH)'.
Recall the common causes of PPH. A useful mnemonic is the '4 T's': Tone, Trauma, Tissue, and Thrombin. Uterine atony (an issue of 'Tone') is the most frequent cause.
Evaluate each option in relation to the '4 T's'.
Analyze 'Twin pregnancy'. This leads to an overdistended uterus, which is a classic cause of uterine atony ('Tone'). This is a strong candidate.
Analyze 'Gestational hypertension'. This can be associated with PPH, often through coagulopathy ('Thrombin') in preeclampsia, but it's a less direct cause of atony than overdistension.
Analyze 'Hyperemesis gravidarum'. This is not a recognized direct cause of PPH.

Concept Tested & Keywords

Concept Tested: Risk factors for Postpartum Hemorrhage (PPH)
Stem keywords: postpartum hemorrhage, PPH, risk factors
Lead-in keywords: Which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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