A multiparous woman delivers vaginally, with an estimated blood loss of 700 mL and a firm uterus. Placenta is complete. Bleeding continues from the birth canal. The most likely cause is:

• A Lower genital tract laceration ✓
• B Uterine atony
• C Retained cotyledon
• D Coagulation failure (DIC)

Explanation

The '4 Ts' of PPH are Tone (atony, most common), Trauma (lacerations), Tissue (retained products), and Thrombin (coagulopathy). When the uterus is firm (good tone) and the placenta is complete (no retained tissue), ongoing bright red bleeding from the birth canal in a patient without known coagulopathy most likely indicates a lower genital tract laceration (cervical, vaginal, or perineal). Inspection of the cervix and vagina under adequate lighting is the immediate next step.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.