You are called to see a woman who has just had a normal vaginal delivery. She is bleeding heavily and the estimated blood loss is already 1500mL. Talk me through your management step by step.

Tips to guide your answer

- Definition: primary PPH is blood loss >500mL after vaginal delivery or >1000mL after caesarean section; major PPH is >1000mL; massive PPH is >2000mL or ongoing with haemodynamic compromise

- Causes - the 4 Ts: Tone (uterine atony, 70 - 80% of cases), Tissue (retained placenta or clots), Trauma (genital tract laceration, uterine inversion), Thrombin (coagulopathy/DIC)

- Estimated blood loss is often only half the actual blood loss - clinical assessment essential

- Uterotonics: IV oxytocin 5IU slow bolus then 40IU infusion, IM ergometrine (avoid if hypertensive), IM carboprost 250mcg (avoid if asthmatic), sublingual misoprostol 800mcg

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How to approach this Obstetrics & Gynaecology interview question

This quality improvement question is common in Obstetrics & Gynaecology NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "You are called to see a woman who has just had a normal vaginal delivery. She is..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.

What the panel is testing

A strong quality-improvement answer uses method as well as enthusiasm. Be clear about the problem, baseline measurement, intervention, re-measurement, and how the change was made sustainable. For obstetrics and gynaecology, show that you can balance urgency, consent, escalation, and multidisciplinary working. Labour ward, theatre, safeguarding, and communication with women and families may all be relevant.

Separate audit, QI, research, and clinical governance clearly so the panel can follow your reasoning.
Use a real cycle: baseline, intervention, re-measurement, learning, and sustainability.
Link the project back to patient safety, service reliability, or measurable outcomes.

How to structure your answer

For a quality improvement prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.

Open by naming the main issue in the question.
Give a structured response rather than a memorised script.
End with escalation, documentation, learning, or follow-up.

Common mistakes to avoid

The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.

Definition: primary PPH is blood loss >500mL after vaginal delivery or >1000mL after caesarean section; major PPH is >1000mL; massive PPH is >2000mL or ongoing with haemodynamic compromise
Causes - the 4 Ts: Tone (uterine atony, 70 - 80% of cases), Tissue (retained placenta or clots), Trauma (genital tract laceration, uterine inversion), Thrombin (coagulopathy/DIC)
Estimated blood loss is often only half the actual blood loss - clinical assessment essential