Which of the following is a high risk factor for Postpartum haemmorhage ?

Question

Question

This question was previously asked in

KGMU Nursing Officer 2023 Memory-Based Previous Year Paper

Answer 1

Correct Answer: Twin pregnancy

Rationale:

Postpartum hemorrhage (PPH) is defined as excessive bleeding after the delivery of a baby, typically more than 500 mL after vaginal delivery or more than 1000 mL after cesarean delivery. It is a leading cause of maternal morbidity and mortality worldwide.
Twin pregnancy is a significant high-risk factor for PPH. Women carrying multiple fetuses (e.g., twins, triplets) are at a higher risk due to the overdistension of the uterus (uterine atony), which makes it less likely to contract effectively after delivery. Uterine atony is the most common cause of PPH.
In addition to uterine atony, twin pregnancies are often associated with prolonged labor, placenta previa, and placental abruption, further increasing the risk of PPH.
Management of PPH in twin pregnancies involves close monitoring during labor and delivery, administration of uterotonic agents, and preparedness for surgical interventions if necessary.

Explanation of Other Options:

Hyperemesis gravidarum

Rationale: Hyperemesis gravidarum is a condition characterized by severe and persistent nausea and vomiting during pregnancy, leading to dehydration and weight loss. While it can cause significant maternal morbidity, it is not a direct risk factor for PPH.

Hypertension in pregnancy

Rationale: Hypertension in pregnancy, including conditions like preeclampsia and eclampsia, can lead to complications such as placental abruption. However, it is not a primary risk factor for PPH itself. The bleeding associated with hypertension-related complications is usually a result of placental issues rather than uterine atony.

Previous cesarean section

Rationale: A previous cesarean section increases the risk of uterine rupture or abnormal placental attachment (e.g., placenta accreta, increta, or percreta), which can lead to severe bleeding. While this is a significant risk factor for specific complications, it is not as commonly associated with PPH due to uterine atony as twin pregnancy.

Conclusion:

Twin pregnancy poses a high risk for postpartum hemorrhage primarily due to uterine overdistension and its effect on uterine contractions post-delivery. This makes it the most relevant answer among the provided options.
Other conditions listed, while potentially serious, are not direct or common causes of PPH and do not carry the same level of risk as twin pregnancy in this context.