12. A woman has delivered 4000g baby within 3 hours since labor starts . At the initial postpartum assessment, fundus is firm and at the level of the umbilicus.But there is heavy brighter red bleeding with occasional small clots. Vital signs are unchanged from prenatal value. What is the best next step of your intervention?(Hidar 2012/December 2019 ) A. Tell the mother it is normal having vaginal discharge after delivery B. Tell the mother it is okay as long as the bleeding is less than 500ml C. Begin aggressive intravenous fluid and oxytocic administration D. Insert speculum and explore cervix , vagina and perineum for tear 13. A 25-year-old woman delivered her baby at a health center. You attempt to deliver the placenta actively with intramuscula oxytocin but it was not successful. She starts to bleed heavily. It has been 40 minute since the delivery of the baby . Despite your attempt, the placenta neither expels out nor it shows sign of separation. What is your best intervention at this level? ( Hidar 2012/December 2019 ) A. Put her on IV fluid,give ampicilline 2 g IV . refer her B. Change oxytocin with ergometrine and attempt CCT once again C. Wait the placenta for additional 20 minutes, attempt manual removal D. Give sedative agent and prophylactic antibiotics, attempt manual removal

12. The correct answer is D. Insert speculum and explore cervix, vagina, and perineum for tear.<br /><br />In this scenario, the woman has delivered a large baby (4000g) and is experiencing heavy bleeding with occasional small clots. The firm fundus and unchanged vital signs indicate that there is no uterine atony or hemorrhage. However, the heavy bleeding suggests that there may be a tear or laceration in the birth canal. Therefore, the best next step is to insert a speculum and explore the cervix, vagina, and perineum for any tears or lacerations. This will help identify the source of bleeding and determine the appropriate treatment.<br /><br />13. The correct answer is C. Wait the placenta for an additional 20 minutes, attempt manual removal.<br /><br />In this scenario, the woman has delivered her baby and is experiencing heavy bleeding despite attempts to deliver the placenta actively with oxytocin. It has been 40 minutes since the delivery, and the placenta does not show signs of separation. The best intervention at this level is to wait for an additional 20 minutes and then attempt manual removal of the placenta. This is known as controlled cord traction (CCT). If the placenta still does not separate, other interventions such as uterine massage, oxytocin augmentation, or even surgical intervention may be necessary.