Match each classic clinical finding in a patient with primary postpartum hemorrhage to its most likely underlying etiology.
- Soft, enlarged uterus palpable above the umbilicus with heavy vaginal bleedingUterine atony
- Firm, well-contracted uterus with a persistent trickle of bright red vaginal bloodGenital tract laceration
- Absence of a cotyledon on visual inspection of the delivered placentaRetained placental tissue
- Generalized oozing from intravenous catheter sites and mucosal surfacesCoagulopathy
Answer
Soft, enlarged uterus matches with Uterine atony. Firm, well-contracted uterus with steady bleeding matches with Genital tract laceration. Absence of a cotyledon matches with Retained placental tissue. Generalized oozing matches with Coagulopathy.
Primary postpartum hemorrhage is most commonly caused by uterine atony, which presents with a boggy uterus. If the uterus is firm but bleeding persists, a genital tract laceration is highly likely. Retained placental tissue is diagnosed when parts of the placenta are visibly missing upon inspection, and systemic oozing points toward a consumptive coagulopathy.
Step-by-Step Solution
Key Concept
The etiologies of primary postpartum hemorrhage are classically categorized by the '4 Ts': Tone (uterine atony), Trauma (genital tract lacerations), Tissue (retained placenta), and Thrombin (coagulopathy).