A woman gives birth vaginally and loses 800 mL of blood in the first hour with a boggy, soft uterus. She is tachycardic. What is the first action?
Answer and explanation
Correct answer: D. Rub up a contraction by uterine massage and give oxytocin
- Step 1: A boggy uterus indicates atony, the commonest cause of PPH.
- Step 2: Massage and uterotonics start immediately, with oxytocin as first-line.
Answer
Rub up a contraction by uterine massage and give oxytocin.
Why not the others: Apply fundal pressure and give carboprost without checking asthma history: Carboprost is contraindicated in asthma and fundal pressure on an atonic uterus is not the first action. Observe for two hours before any intervention: Delay increases blood loss. Give ergometrine 500 micrograms IM immediately even though she is hypertensive: Ergometrine is contraindicated in hypertension.
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