A 35-year-old G4P3 woman delivers vaginally at term. The placenta is delivered 30 minutes later and appears complete. She is then found to have soaked 4 pads in 30 minutes. Uterine massage reveals a soft, boggy uterus. Her blood pressure is 90/60 mmHg. The MOST likely cause and the FIRST-LINE drug treatment are:

• A Retained products; manual removal under anaesthesia
• B Cervical laceration; suturing
• C Uterine atony; oxytocin ✓
• D Uterine inversion; tocolytics

Explanation

Uterine atony is the most common cause of primary postpartum haemorrhage, accounting for approximately 70–80% of cases. Risk factors include grand multiparity, overdistended uterus, and prolonged labour. The classic finding is a soft, boggy uterus. Oxytocin (10–20 IU IV infusion) is the first-line uterotonic for atony. Subsequent agents include ergometrine, carboprost (15-methyl PGF2α), and misoprostol if oxytocin fails.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.