A 29yo woman had just delivered a still born vaginally, following a major placental abruption.
Choose the single most likely predisposing factor for developing PPH in this lady?
a. Retained product
b. DIC
c. Fibroid uterus
d. Uterine infection
e. Large placental site
answer: placental abruption is a cause of DIC, so B
if atony was on the list it would be that as its more common
causes of PPH
1. Tone
ƒ uterine atony
Š most common cause of PPH
Š avoid by giving oxytocin with delivery of the anterior shoulder or placenta
Š occurs within first 24 h
ƒ due to
Š labor (prolonged, precipitous, induced, augmented)
Š uterus (infection, over-distention)
Š placenta (abruption, previa)
Š maternal factors (grand multiparity, gestational HTN)
Š halothane anesthesia
2. Tissue
ƒ retained placental products
ƒ retained blood clots in an atonic uterus
ƒ gestational trophoblastic neoplasia
3. Trauma
ƒ laceration (vagina, cervix, uterus), episiotomy, hematoma (vaginal, vulvar, retroperitoneal),
uterine rupture, uterine inversion
4. Thrombinƒ coagulopathy
Š most identified prior to delivery (low platelets increases risk)
Š includes hemophilia, DIC, Aspirin® use, ITP, TTP, vWD (most common)
Š therapeutic anti-coagulation
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