Following an uncomplicated vaginal delivery of a 4.0 kg infant, a 28-year-old mother experiences heavy continuous vaginal bleeding. The placenta was delivered intact 10 minutes ago. Palpation of the abdomen reveals a soft, boggy, poorly contracted uterus above the umbilicus. What is the most common cause of primary postpartum hemorrhage (PPH)?
Answer and explanation
Correct answer: B. Uterine atony
- Step 1: Uterine atony accounts for 70% to 80% of all primary postpartum hemorrhage cases.
- Step 2: Failure of the myometrium to contract effectively prevents occlusion of the spiral arteries supplying the placental bed, resulting in a soft, boggy uterus and brisk hemorrhage.
Answer
Uterine atony.
Why not the others: 'Retained placental cotyledon' accounts for roughly 10% of cases and causes persistent bleeding despite uterotonic therapy; 'Lower genital tract laceration' produces steady bright red bleeding despite a well-contracted, firm fundus; 'Disseminated intravascular coagulation' presents with systemic coagulopathy and oozing from venipuncture sites.
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