A sixth gravida has postpartum hemorrhage immediately after a spontaneous vertex delivery. The placenta and membranes are expelled completely. The uterus is not very firm. The first-line of treatment would be
A. Blood transfusionB. Massaging the uterus and administering an oxytocic
C. Inspecting the vagina and cervix for laceration
D. Exploring the uterine cavity
Answer.B (Massaging the
uterus and administering an oxytocic)
Postpartum bleeding: Hemorrhage in excess of 500 ml from genital tract after
delivery,
(a) Primary: within 24
hours following birth,
(b) Secondary: after 24 hours.
Causes
1. Atonic uterus (80%)—commonest cause. Conditions often interfere with retraction of the uterus—grand multipara, overdistension of uterus as in multiple pregnancy, hydramnios, and large baby malnutrition and anemia, prolonged labor, uterine seda tives, uterine fibroid, induced labor placenta previa malformed uterus.
1. Atonic uterus (80%)—commonest cause. Conditions often interfere with retraction of the uterus—grand multipara, overdistension of uterus as in multiple pregnancy, hydramnios, and large baby malnutrition and anemia, prolonged labor, uterine seda tives, uterine fibroid, induced labor placenta previa malformed uterus.
2. Traumatic (20%).
3. Combined.
