After an uncomplicated vaginal delivery, a woman has an estimated blood loss of 900 mL over 30 minutes. The uterus is well-contracted, the placenta delivered completely, and there is no perineal or cervical laceration. The next most appropriate step is:

• A Bimanual uterine compression and examination under anesthesia
• B Intrauterine Bakri balloon tamponade
• C Check for coagulopathy and transfuse fresh frozen plasma
• D Administer IV tranexamic acid 1 g ✓

Explanation

The uterus is contracted, placenta is out, and there are no genital tract lacerations — yet bleeding continues. The WOMAN trial (Lancet 2017) demonstrated that early administration of tranexamic acid (1 g IV within 3 hours of delivery) significantly reduced mortality due to postpartum hemorrhage when given within 3 hours of PPH onset. With a contracted uterus, excluded retained placenta and genital trauma, a coagulopathy or unidentified small vessel source is likely; tranexamic acid is the evidence-based next step before escalating to surgical measures.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.