A nurse is caring for a client who had a vaginal delivery 4 hours ago.

The nurse notes that the client’s fundus is boggy, deviated to the right, and above the umbilicus.

The client’s perineal pad is saturated with blood.

What is the most likely cause of this client’s postpartum hemorrhage?

The client has severe coagulation impairment.

This is because the client’s platelet count, fibrinogen level, and prothrombin time are all significantly abnormal compared to the normal ranges.

• The normal platelet count is 150,000 to 450,000/mm3.

A platelet count of 80,000/mm3 indicates thrombocytopenia, which is a low number of platelets that can impair clotting and cause bleeding.

• The normal fibrinogen level is 200 to 400 mg/dL.

A fibrinogen level of 150 mg/dL indicates hypofibrinogenemia, which is a low level of fibrinogen that can impair clotting and cause bleeding.

• The normal prothrombin time is 11 to 13.5 seconds.

A prothrombin time of 18 seconds indicates a prolonged clotting time that can impair clotting and cause bleeding.

Choice A is wrong because the client does not have normal coagulation parameters.

All three tests are abnormal and indicate a severe coagulation impairment.

Choice B is wrong because the client does not have mild coagulation impairment.

The degree of abnormality in the test results is too high to be considered mild.

Choice C is wrong because the client does not have moderate coagulation impairment.

The degree of abnormality in the test results is too high to be considered moderate.

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.A boggy, deviated and above the umbilicus fundus indicates uterine atony.

Choice B. Retained placenta is wrong because it occurs when some or all of the placenta remains in the uterus after delivery.It can also cause postpartum hemorrhage, but it usually presents with a firm fundus and a continuous trickle of blood.

Choice C. Uterine inversion is wrong because it is a rare condition where the uterus turns inside out after delivery.It can also cause postpartum hemorrhage, but it usually presents with severe pain, shock and a palpable mass at the introitus.

Choice D. Cervical laceration is wrong because it is a tear in the cervix that can occur during delivery.It can also cause postpartum hemorrhage, but it usually presents with a firm fundus and bright red bleeding that does not respond to uterine massage.