A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage.
Choose the single most likely predisposing factor for PPH for this pt?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained product
d. Preterm labor
e. Uterine infection
answer: B
1. Tone
uterine atony
most common cause of PPH
avoid by giving oxytocin with delivery of the anterior shoulder or placenta occurs within first 24
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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