Which of the following complications is a risk factor for delayed postpartum haemorrhage?

IGNOU Post B. SC. Nursing entrance -2021

Obstetrics & Gynaecology

Easy

Appeared in: IGNOU Post B. SC. Nursing entrance -2021

Explanation

Delayed, or secondary, postpartum hemorrhage (PPH) is defined as excessive bleeding occurring from 24 hours to 12 weeks after delivery.
The most common cause of delayed PPH is uterine subinvolution, which is the failure of the uterus to return to its normal non-pregnant size.
Subinvolution is typically caused by retained placental fragments or infection (endometritis).
These conditions prevent the myometrium from contracting effectively, leading to persistent bleeding from the unhealed placental site.

Option A: This is a form of trauma to the birth canal that occurs during delivery.
Option C: While a clotting deficiency can cause postpartum bleeding, it is not the most common or specific risk factor for delayed PPH.
Option D: This is a traumatic injury to the perineum that occurs during childbirth.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Delayed (Secondary) Postpartum Hemorrhage as background academic context rather than a clinical decision trigger.
A key nursing responsibility is postpartum discharge education. Nurses must teach patients to recognize and immediately report signs of delayed PPH, such as a return to bright red bleeding after lochia has turned pink or white (lochia serosa/alba), foul-smelling lochia, fever, and uterine tenderness.
Early recognition and management, which may include uterotonic medications, antibiotics, or surgical intervention (curettage), are crucial to prevent severe morbidity.
What if? If a patient at 6 hours postpartum has a steady trickle of bright red blood but her uterine fundus is firm and at the umbilicus, the nurse should suspect a cervical or vaginal laceration (Trauma) rather than uterine atony (Tone). The provider should be notified for a speculum examination to identify and repair the source of bleeding.

How to Approach the Question

First, identify the key phrase in the question: 'delayed postpartum haemorrhage'.
Recall the definition of delayed (or secondary) PPH, which is bleeding that occurs after the first 24 hours postpartum.
Evaluate each option based on its typical onset of bleeding.
Recognize that 'laceration' (both cervical and perineal) is a form of trauma that happens during birth and would cause immediate bleeding.
Eliminate the laceration options as causes of primary, not delayed, PPH.
Compare the remaining options. Uterine subinvolution is the specific term for the failure of the uterus to shrink properly over days to weeks, making it the most direct cause of delayed bleeding. Clotting deficiency is a less specific cause.

Concept Tested & Keywords

Concept Tested: Causes of Delayed (Secondary) Postpartum Hemorrhage
Stem keywords: delayed postpartum haemorrhage, complications, risk factor
Lead-in keywords: Which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.