A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin.
She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of afterbirth hemorrhage in this woman is:
Retained placental fragments.
Unrepaired vaginal lacerations.
Uterine atony
Puerperal infection
The Correct Answer is C
Uterine atony.
This is when the uterus does not contract enough to stop the bleeding from the placental site after delivery. It is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases. Uterine atony can be caused by factors such as prolonged or augmented labor, large baby, multiple pregnancies, infection, or retained placenta.
The woman in question has some risk factors for uterine atony, such as a large baby and augmentation of labor with Pitocin.
The other choices are wrong because:
A . Retained placental fragments: This is when parts of the placenta remain attached to the uterine wall and prevent it from contracting properly. It is the second most common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any difficulty with the delivery of the placenta or that it was incomplete
B. Unrepaired vaginal lacerations: This is when there are tears or cuts in the vagina or cervix that cause bleeding. It is a less common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any trauma during delivery or that she was examined for lacerations
D. Puerperal infection: This is when there is an infection in the uterus or other parts of the reproductive tract after delivery.
It can cause fever, pain, and bleeding. It is a rare cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any signs or symptoms of infection, such as fever, chills, or foul-smelling discharge.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal birth and less than 1000 mL for C-section.
Any amount above these thresholds can be considered postpartum hemorrhage and requires prompt evaluation and treatment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Uterine atony.
This is when the uterus does not contract enough to stop the bleeding from the placental site after delivery. It is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases. Uterine atony can be caused by factors such as prolonged or augmented labor, large baby, multiple pregnancies, infection, or retained placenta.
The woman in question has some risk factors for uterine atony, such as a large baby and augmentation of labor with Pitocin.
The other choices are wrong because:
A . Retained placental fragments: This is when parts of the placenta remain attached to the uterine wall and prevent it from contracting properly. It is the second most common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any difficulty with the delivery of the placenta or that it was incomplete
B. Unrepaired vaginal lacerations: This is when there are tears or cuts in the vagina or cervix that cause bleeding. It is a less common cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any trauma during delivery or that she was examined for lacerations
D. Puerperal infection: This is when there is an infection in the uterus or other parts of the reproductive tract after delivery.
It can cause fever, pain, and bleeding. It is a rare cause of postpartum hemorrhage.
However, there is no indication in the question that the woman had any signs or symptoms of infection, such as fever, chills, or foul-smelling discharge.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal birth and less than 1000 mL for C-section.
Any amount above these thresholds can be considered postpartum hemorrhage and requires prompt evaluation and treatment.
Correct Answer is ["A","B","C","D"]
Explanation
These are all positive signs of pregnancy, which are definitive and can only be explained by the presence of a fetus.A positive sign of pregnancy is fetal movement palpated by the nurse-midwife.
Choice E is wrong because a positive hCG test is a probable sign of pregnancy, not a positive one.A probable sign of pregnancy is strongly suggestive of pregnancy but could have other causes.A positive hCG test could be caused by medications, tumors, or other conditions that affect the level of hCG in the blood or urine.
Some other probable signs of pregnancy are uterine enlargement, Hegar’s sign (softening of the lower uterine segment), Goodell’s sign (softening of the cervix), Chadwick’s sign (bluish discoloration of the cervix), ballottement (rebound of the fetus when tapped by the examiner’s finger), Braxton Hicks contractions (painless, irregular uterine contractions), and positive pregnancy test.
Some other positive signs of pregnancy are identification of fetal heartbeat, visualization of the fetus by ultrasound or x-ray, and verification of fetal movement by an experienced clinician.
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