Immediately following an uncomplicated vaginal delivery of a 4.1 kg infant, a mother develops massive continuous vaginal bleeding. The uterine fundus is soft, boggy, and palpated above the umbilicus. What is the most common cause of postpartum hemorrhage?
Answer and explanation
Correct answer: D. Uterine atony (failure of effective myometrial contraction)
- Step 1: Postoperative/postpartum hemorrhage causes follow the '4 Ts': Tone (atony, 70-80%), Trauma (lacerations, 20%), Tissue (retained placenta, 10%), Thrombin (coagulopathy, 1%).
- Step 2: Uterine atony is by far the leading cause of postpartum hemorrhage.
- Step 3: Immediate management includes bimanual uterine massage, intravenous oxytocin infusion, and additional uterotonic agents (ergometrine, carboprost, misoprostol).
Answer
Uterine atony (failure of effective myometrial contraction).
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