A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot"
The most likely cause of postpartum hemorrhage in this woman is: a. Retained placental fragments.
b. Unrepaired vaginal lacerations.
c. Uterine atony.
d. Puerperal infection.
C
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A Although retained placental fragments may cause postpartum hemorrhage, this typically would be detected in the first hour after delivery of the placenta and is not the most likely cause of hemorrhage in this woman.
B Although unrepaired vaginal lacerations may cause bleeding, they typically would occur in the period immediately after birth.
C This woman gave birth to a macrosomic boy after Pitocin augmentation. The most likely cause of bleeding 4 hours after delivery, combined with these risk factors, is uterine atony.
D Puerperal infection can cause subinvolution and subsequent bleeding, but it typ-ically would be detected 24 hours after delivery.
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