A 24-year-old primigravida delivers vaginally. Active management of third stage is given with oxytocin 10 IU IM. The placenta is delivered at 12 minutes. The next 5 minutes show 200 mL blood loss with a contracted uterus. On examination at 30 minutes postpartum, the fundus is at the umbilicus and boggy, with active bleeding. What is the most appropriate next step?
- A Manual removal of placenta
- B Bimanual uterine compression and additional uterotonics ✓
- C Hysterectomy
- D Uterine artery embolization
Correct answer: B. Bimanual uterine compression and additional uterotonics
Explanation
A boggy uterus at 30 minutes postpartum after placental delivery indicates uterine atony, the most common cause of PPH. First-line management is bimanual compression plus additional uterotonics (ergometrine or misoprostol). Manual removal is for retained placenta. Hysterectomy is a last resort after stepwise failure of conservative measures.
Reference: Dutta's Textbook of Obstetrics, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.