PF for PPH (175/1700)

A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted.
Choose the single most likely predisposing factor for PPH from the options?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained POC
d. Large placental site
e. Rupture uterus


























Answer: B ........ large sized fetus...atony would be a good option due to over distention except that it says the uterus is involuted so it can't be atony. Therefore it's most likely going to be trauma from deliverly of the large baby.


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

• labor (prolonged, precipitous, induced, augmented)
• uterus (infection, over-distention)
• placenta (abruption, previa)
• maternal factors (grand multiparity, gestational HTN)
• halothane anesthesia

2. Tissue

• retained placental products
• retained blood clots in an atonic uterus
• gestational trophoblastic neoplasia

3. Trauma

• laceration (vagina, cervix, uterus), episiotomy, hematoma (vaginal, vulvar, retroperitoneal), uterine rupture, uterine inversion

4. Thrombinƒ coagulopathy

• most identified prior to delivery (low platelets increases risk)
• includes hemophilia, DIC, Aspirin® use, ITP, TTP, vWD (most common)
• therapeutic anti-coagulation