A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin.
She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of afterbirth hemorrhage in this woman is:
A.
Retained placental fragments.
B.
Unrepaired vaginal lacerations.
C.
Uterine atony
D.
Puerperal infection
The correct answer and Explanation is :
The most likely cause of postpartum hemorrhage in this scenario is C. Uterine atony.
Explanation:
Postpartum hemorrhage (PPH) is a significant complication following childbirth and is defined as blood loss of more than 500 mL after vaginal delivery or 1000 mL after cesarean delivery. It can occur within the first 24 hours of delivery (primary PPH) or later (secondary PPH).
Uterine Atony
Uterine atony is the most common cause of postpartum hemorrhage, responsible for up to 80% of cases. After delivery, the uterus typically contracts to compress the blood vessels and stop bleeding. When the uterus fails to contract adequately, known as uterine atony, the blood vessels remain open, leading to excessive bleeding. Several factors may contribute to uterine atony in this case:
- Augmentation of Labor with Pitocin (Oxytocin): Prolonged use of Pitocin can desensitize the uterine receptors, leading to ineffective contractions after delivery.
- Multiparity (Gravida 2, Para 2): Women who have had multiple pregnancies may have a more distended uterus, which can reduce its ability to contract effectively.
- Large Baby (9-lb, 7-ounce): A larger baby can cause overdistension of the uterus, making it more difficult for the uterus to contract post-delivery.
Other Options:
- A. Retained placental fragments: This can cause PPH but usually manifests later when fragments prevent complete uterine contraction.
- B. Unrepaired vaginal lacerations: These can cause bleeding but are often identified and repaired immediately post-delivery.
- D. Puerperal infection: Infection may lead to late PPH but is not the most common cause of immediate heavy bleeding within the first few hours after birth.
In summary, uterine atony is the most likely cause of this patient’s postpartum hemorrhage due to her clinical factors.