A 30-year-old delivers vaginally after a prolonged third stage. Post-delivery blood loss is 650 mL and bleeding continues. Bimanual massage is performed, syntocinon is given, but bleeding persists. The uterus is well-contracted. The next step in management is:
- A Inspect the birth canal for lacerations and check placenta for completeness ✓
- B Administer carboprost 250 mcg IM
- C Perform internal iliac artery ligation
- D Insert an intrauterine balloon tamponade
Correct answer: A. Inspect the birth canal for lacerations and check placenta for completeness
Explanation
When the uterus is well-contracted but PPH continues, atony is excluded and the cause must be sought among the other '4 Ts': trauma (lacerations), tissue (retained placenta or membranes), and thrombin (coagulopathy). The immediate step is systematic inspection of the cervix, vagina, and perineum for lacerations, and examination of the placenta for completeness. Uterotonic agents (carboprost) address atony and are not useful if the uterus is contracted. Surgical interventions come later if conservative measures fail.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.