A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most
likely predisposing factor for postpartum hemorrhage?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Rupture uterus
d. Fibroid uterus
e. Age of mother
answer: A
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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