Postpartum Hemorrhage

About this case

A 29-year-old has lost 2,400 mL within 30 minutes after vaginal delivery, with a boggy uterus and falling blood pressure. The case escalates while you manage it, so the examiner is assessing whether your resuscitation keeps pace with the bleeding.

Key clinical features

• Uterine Atony

  Most common cause of PPH — boggy uterus after delivery

• Hemorrhagic Shock

  BP 78/44, HR 128 — Class III–IV hemorrhage

• MTP Activation

  1:1:1 pRBC:FFP:Plt ratio — balanced resuscitation

• Coagulopathy Risk

  DIC can develop rapidly in obstetric hemorrhage

What the examiner is testing

• Whether you resuscitate and treat the cause in parallel rather than sequentially.
• Your triggers for activating a massive transfusion protocol and the ratio-based approach you would use.
• Recognition that obstetric haemorrhage can produce coagulopathy quickly, and how that changes monitoring.
• How you escalate — including when definitive surgical management becomes the right answer rather than a failure.

Where candidates lose points

• Under-calling the degree of shock and resuscitating behind the blood loss.
• Transfusing red cells alone without addressing coagulation factors.
• Waiting too long to involve surgical management, then being unable to justify the delay.

How it is scored

Every BoardSim case is scored across the same five phases — pre-operative evaluation, anaesthetic plan, intra-operative management, crisis management, and emergence — for a total of 100 points, with a pass set at 70 and no missed critical action. You receive a written report against each phase rather than a single number. Read the scoring methodology.