A woman delivered vaginally 30 minutes ago and has now bled 1200 mL. Uterine massage and oxytocin infusion have been given. The uterus is firm. What is the MOST likely cause of postpartum hemorrhage?

• A Uterine atony
• B Retained placental tissue
• C Uterine inversion
• D Lower genital tract laceration ✓

Explanation

The '4 T's' of PPH are Tone, Tissue, Trauma, and Thrombin. In this case, the uterus is firm (ruling out atony), and the placenta has been delivered. With a firm uterus and ongoing bleeding after vaginal delivery, genital tract laceration (Trauma) must be immediately inspected and repaired. Systematic examination of the cervix, vaginal walls, and perineum is mandatory when the uterus is well-contracted but bleeding persists.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.