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 oxytocin (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 hemorr-hage in this woman is: 1. retained placental fragments.
2. unrepaired vaginal lacerations.
3. uterine atony.
4. puerperal infection.
3
1. Incorrect. Although retained placental fragments may cause PP hemorrhage, typically this would be detected in the first hour following delivery of the placenta and is not the most likely cause of hemorrhage in this woman.
2. Incorrect. Although unrepaired vaginal lacerations may cause bleeding, they would typi-cally occur in the period immediately after birth.
3. Correct. This woman gave birth to a macrosomic boy following Pitocin augmentation. The most likely cause of bleeding 4 hours after delivery, combined with these risk factors, would be due to uterine atony.
4. Incorrect. Puerperal infection can cause subinvolution and subsequent bleeding, but would typically be detected after 24 hours postpartum.
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