A 28-year-old G2P2 woman at 39 weeks gestation undergoes an uncomplicated spontaneous vaginal delivery of a healthy neonate. During the immediate postpartum period, her vital signs are blood pressure 110/70 mm Hg, heart rate 85/min, and temperature 37.1 C (98.8 F). Match the following potential clinical presentations during the third and fourth stages of labor to their most likely underlying etiology.
- Soft, boggy, poorly contracted uterus palpated above the umbilicus with heavy vaginal bleedingUterine atony
- Firm, well-contracted uterus with a continuous trickling of bright red vaginal bloodGenital tract laceration
- Smooth, round mass protruding from the vagina with an absent uterine fundus on abdominal palpationUterine inversion
- Failure of the placenta to separate and deliver within 30 minutes of the infant's birthRetained placenta
Cevap
A soft, boggy uterus matches uterine atony. A firm uterus with trickling bleeding matches genital tract laceration. An absent fundus with a vaginal mass matches uterine inversion. No placental delivery after 30 minutes matches a retained placenta.
Each etiology of postpartum hemorrhage and abnormal third stage of labor has distinct examination findings. Uterine atony (the most common cause of postpartum hemorrhage) presents with a soft, poorly contracted uterus. Genital tract lacerations present with active bleeding while the uterus remains firm. Uterine inversion is an emergency presenting with a vaginal mass and a nonpalpable fundus. Retained placenta is simply defined by the time elapsed (over 30 minutes) without placental delivery.
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Anahtar Kavram
Clinical presentation and etiologies of postpartum hemorrhage