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 you 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 delivere d her baby at a healt h center. You attempt to deliver the placenta actively with intramuscular oxytocin but it was not successfu l.She starts to blee d heavily. It has been 40 minute since the delivery of the baby . Despite your attempt , the placenta neithe r expels out nor it shows sign of separation. What is your best intervention I at this level?(Hidar 2012/December 2019) A. Put her on IV fluid give ampicilline 2 g IV, refer her B. Change oxytocir I with ergometrine and attempt CCT once again C. Wait the placenta for additiona 120 minutes,attempt manua l removal D. Give sedative agent and prophylactic antibiotics , attempt manual removal 14. A 37 -year-old woman comes to family planning unit demanding highly effective contraceptiv e method . The doctor told her pregnancy could endange her life because she has advanced heart disease.She does not accept tubal ligation as an option. Which contraceptive method is best to satisfy her need?( Hidar 2012/December 2019) A. IUCD B Implants

12. The correct answer is D. Insert speculum and explore cervix, vagina, and perineum for tear.<br /><br />Explanation: The woman is experiencing heavy bleeding with occasional small clots, which could indicate a postpartum hemorrhage. The firm fundus and the level of the umbilicus suggest that the uterus is not contracting properly. Therefore, it is essential to check for any tears or retained fragments in the uterus that could be causing the bleeding. Inserting a speculum and exploring the cervix, vagina, and perineum for tears is the best next step to determine the cause of the bleeding and initiate appropriate treatment.<br /><br />13. The correct answer is C. Wait for an additional 20 minutes and attempt manual removal.<br /><br />Explanation: The woman is experiencing heavy bleeding and has not delivered the placenta despite attempts with intramuscular oxytocin. It has been 140 minutes since delivery, and the placenta is not showing signs of separation. In this situation, it is crucial to wait for an additional 20 minutes and attempt manual removal of the placenta. If the bleeding continues or if the placenta cannot be removed manually, further interventions such as administering prostaglandins or performing a hysterectomy may be necessary.<br /><br />14. The correct answer is B. Implants.<br /><br />Explanation: The woman has advanced heart disease and is not willing to undergo tubal ligation. In this case, hormonal methods of contraception, such as implants, would be the best option. Implants are highly effective and do not require surgical intervention. They can be safely used in women with heart disease as they do not affect blood clotting. However, it is essential to discuss the potential risks and benefits with the woman and ensure that she understands the implications of using hormonal contraception with her medical condition.