106 Obstetrics and Gynecology Board Review •••
❍ What are the three most common symptoms of episiotomy infection?
Pain, purulent discharge, and fever.
❍ How is episiotomy infection treated?
Open and drain wound and broad-spectrum antibiotics.
❍ True or False: Vulvar hematomas most commonly result from injury to the branches of a descending uterine
artery.
False. Pudendal artery.
❍ What is the most common presenting symptom of vulvar hematoma?
Pain.
❍ True or False: Surgical drainage is the best treatment of a 3 cm nonexpanding hematoma in a patient
experiencing a mild degree of pain.
False. Expectant management is appropriate.
❍ What is the definition of primary postpartum hemorrhage?
Postpartum hemorrhage occurring within 24 hours of delivery.
❍ What is the most common cause of primary postpartum hemorrhage?
80% of cases are due to uterine atony.
❍ What other etiologies should be considered in primary postpartum hemorrhage not responsive to uterine
massage, expelling of clots, and medical management?
Retained placenta, placenta accreta, coagulation deficits, uterine inversion, and lower genital tract laceration.
❍ What are common risk factors for primary postpartum hemorrhage?
Prolonged labor, augmented labor, rapid labor, history of postpartum hemorrhage, preeclampsia, operative delivery,
chorioamnionitis, and uterine distention (ie, twin gestation, macrosomic infant, and polyhydramnios).
❍ What are options for medical management of postpartum hemorrhage?
Oxytocin, Methergine, Hemabate, Dinoprostone, or Cytotec.
❍ In the event of failure of medical management, what steps can be taken for a patient experiencing postpartum
hemorrhage?
Examination in operating room for lacerations or uterine inversion, dilation and evacuation of retained placenta,
placement of an O’Leary stitch (uterine artery ligation), B-lynch suture, or a Bakri balloon can also be used to achieve
hemostasis. Analysis for coagulopathy should additionally be considered.
❍ What is the definition of secondary postpartum hemorrhage?
Postpartum hemorrhage occurring >24 hours and <6 to 12 weeks after delivery.