A woman delivers vaginally and 20 minutes later develops brisk vaginal bleeding. The uterus is firm and well-contracted on palpation. Placenta has been delivered completely. The most likely cause of her haemorrhage is:

• A Uterine atony
• B Retained placental fragments
• C Genital tract laceration ✓
• D Coagulation disorder

Explanation

The '4 T's' of PPH are Tone, Tissue, Trauma, and Thrombin. A firmly contracted uterus with complete placenta delivery excludes atony and retained tissue; therefore the source is trauma — a cervical, vaginal, or perineal laceration. Systematic inspection of the genital tract under good lighting is the next step. Coagulation disorders typically present later and with generalised oozing.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.