A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:
1. uterine atony.
2. uterine inversion.
3. vaginal hematoma.
4. vaginal laceration.
1
1. Correct. Uterine atony is marked hypotonia of the uterus. It is the leading cause of post-partum hemorrhage.
2. Incorrect. Uterine inversion may lead to hemorrhage, but is not the most likely source of this client's bleeding. Furthermore, it would be evident if the woman were experiencing a uterine inversion by the presence of a large, red, rounded mass protruding from the introitus.
3. Incorrect. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding.
4. Incorrect. A vaginal laceration may cause hemorrhage but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues with the presence of a firm, contracted uterine fundus.
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