Management of Post-Partum Hemorrhage on the Step 2 CK exam

by / Wednesday, 09 June 2010 / Published in OB/GYN

The most common cause of PPH is uterine atony (weak contraction)

This occurs commonly with:

  • Twins
  • Hydramnios
  • Multipartiy



1st – goal is to make the uterus contract

Give:  Oxytocin, if this does not work….

Give: Methergine, if this does not work…

Give: Prostaglanding

After trying these 3 drugs, if bleeding continues, do the following:

  • Bilateral uterine artery ligation (this can be done because collateral circulation is present)

If bleeding is still present, do a….

  • Bilateral hypogastric artery ligation

If bleeding is still present, do a….

  • Hysterectomy



  1. Oxytocin
  2. Methergine
  3. Prostaglandin
  4. Bilateral Uterine Artery Ligation
  5. Bilateral Hypogastric Artery Ligation
  6. Hysterectomy

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