Which of the following is most common cause of immediate PPH?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

Explanation

Immediate, or primary, postpartum hemorrhage (PPH) is defined as excessive blood loss (typically greater than 500 mL for vaginal birth) occurring within the first 24 hours after delivery.
Uterine atony is the failure of the myometrium (uterine muscle) to contract effectively after the placenta is delivered.
This lack of contraction is the single most frequent cause of immediate PPH, accounting for 70-80% of cases.
When the uterus does not contract, the blood vessels at the former placental implantation site are not compressed, leading to continuous and heavy bleeding.

Option B: Puerperal sepsis is an infection of the genital tract occurring after delivery. It is a recognized cause of secondary (late) PPH, which occurs after 24 hours, not immediate PPH.
Option C: A prolapsed umbilical cord is an obstetric emergency that compromises fetal oxygen supply. It is a critical risk to the fetus, not a cause of maternal hemorrhage.
Option D: Premature Rupture of Membranes (PROM) is the rupture of the amniotic sac before the onset of labor. While it can lead to complications like infection or prolonged labor (which is a risk factor for atony), it is not a direct cause of PPH itself.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Immediate Postpartum Hemorrhage as background academic context rather than a clinical decision trigger.
Nurses must be able to rapidly assess for uterine atony by palpating the fundus post-delivery. A firm, midline fundus is expected; a boggy or soft uterus indicates atony and requires immediate intervention.
First-line nursing interventions for uterine atony include vigorous fundal massage to stimulate contraction, encouraging the mother to void (a full bladder can displace the uterus and prevent contraction), and administering prescribed uterotonic medications like oxytocin.
What if? - If a patient is bleeding heavily but the uterine fundus is firm and midline, the nurse should suspect trauma (lacerations) as the cause, not atony. The priority would shift to notifying the provider for a speculum exam to identify and repair any tears.

How to Approach the Question

First, identify the key terms in the question: 'most common cause' and 'immediate PPH'.
Define 'immediate PPH' in your mind as significant bleeding that occurs within the first 24 hours after birth.
Evaluate each option based on its definition and timing in relation to childbirth.
Atonic Uterus: This is the failure of the uterus to contract right after delivery, which is a direct and immediate cause of bleeding.
Puerperal Sepsis: This is an infection that typically develops days after delivery, making it a cause of late, not immediate, PPH.
Prolapsed cord: This is a complication involving the fetus and umbilical cord during labor, not a cause of maternal bleeding after birth.

Concept Tested & Keywords

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E6 Obstetrics Williams pp. 47-67, 48-69