A 30-year-old G3P2 delivers vaginally and has an estimated blood loss of 900 mL. The uterus is well contracted. Placenta is delivered whole. Perineal tear repair is complete. Persistent brisk bleeding continues from the vaginal vault. The NEXT step is:
- A Bimanual uterine compression
- B Systematic examination of the genital tract for lacerations or haematoma ✓
- C Intrauterine balloon tamponade
- D Intravenous ergometrine
Correct answer: B. Systematic examination of the genital tract for lacerations or haematoma
Explanation
When the uterus is well contracted and placenta is complete, the most likely cause of ongoing PPH is a genital tract laceration or vault haematoma (the '4 Ts': Tone, Tissue, Trauma, Thrombin). Systematic inspection of the cervix, vagina, and vault under good lighting is the priority. Bimanual compression and uterotonics address tone; they are inappropriate when the uterus is already contracted. Balloon tamponade is a later measure once lacerations are excluded.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.