Match each classic clinical presentation of postpartum hemorrhage to its most likely underlying etiology.
- Profuse vaginal bleeding with a soft, boggy uterus palpated above the umbilicus following a prolonged labor.Uterine atony
- Continuous vaginal bleeding with a firm, well-contracted uterus palpated at the umbilicus following a forceps-assisted delivery.Genital tract laceration
- Severe postpartum abdominal pain with a round, red mass protruding from the vagina and an unpalpable uterine fundus.Uterine inversion
- Persistent vaginal bleeding with a firm uterus; inspection of the delivered placenta reveals a missing lobule.Retained placenta
Answer
The presentations match their respective classic etiologies based on uterine tone and physical exam findings.
Each etiology of postpartum hemorrhage has a distinct presentation. Uterine atony lacks uterine tone (boggy). Lacerations present with bleeding despite good tone. Uterine inversion presents with an absent fundus and visible mass. Retained placenta presents with missing cotyledons.
Step-by-Step Solution
Key Concept
The etiologies of postpartum hemorrhage (the '4 Ts': Tone, Trauma, Tissue, Thrombin) can be differentiated by assessing uterine tone, physical exam findings, and placental integrity.