Most Common Cause Of Postpartum Bleeding

The most common cause of postpartum bleeding is
A) Retained placenta
B) Vaginal laceration
C) Uterine atony
D) Coagulopathy
E) HELLP syndrome

Answer and Discussion

The answer is C. Uterine atony

Hemorrhage after placental delivery should prompt vigorous fundal massage while the patient is rapidly given oxytocin in their intravenous fluid. If the fundus does not become firm, uterine atony is the presumed (and most common) diagnosis. While fundal massage continues, the patient may be given methylergonovine (Methergine) intramuscularly, with the dose repeated at 2- to 4-hour intervals if necessary.
Methylergonovine may cause cramping, headache, and dizziness. The use of this drug is contraindicated in patients with hypertension.
Carboprost (Hemabate), 15-methyl prostaglandin F2a, may be administered intramuscularly or intramyometrially every 15 to 90 minutes, up to a maximum dosage. As many as 68% of patients respond to a single carboprost injection, with 86% responding by the second dose.
Another prostaglandin that is increasingly used in the treatment of postpartum hemorrhage is misoprostol which is most commonly administered rectally in a 800-to-1,000-mcg dose, though it can also be administered buccally or vaginally.