Which of the following is the major cause for PPH?

Appeared in: NHM MP Staff Nurse-2019

Explanation

Atonic uterus, or uterine atony, is the failure of the myometrium to contract sufficiently after childbirth.
This lack of contraction prevents the compression of the spiral arteries at the placental site, leading to continuous and excessive bleeding.
It is the single most common cause of postpartum hemorrhage (PPH), responsible for approximately 80% of all cases.
Risk factors for atonic uterus include overdistension of the uterus (from multiple pregnancies, a large fetus, or polyhydramnios), prolonged labor, and the use of certain anesthetic agents.

Option B: While traumatic PPH (due to lacerations of the genital tract) is a significant cause of postpartum bleeding, it is not the major or most common cause. It accounts for about 20% of PPH cases.
Option C: This option is incorrect because the question asks for the major cause. While both are causes, atonic uterus is overwhelmingly more common than traumatic PPH.
Option D: This is incorrect because a major cause of PPH is listed as an option.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Postpartum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
Immediate assessment of uterine tone by fundal palpation is a critical nursing responsibility after delivery. A soft, boggy uterus requires immediate intervention.
The first-line nursing intervention for a boggy uterus is vigorous fundal massage to stimulate contraction, while simultaneously calling for help and preparing uterotonic medications.
Nurses must be able to differentiate between atonic and traumatic PPH. If fundal massage and uterotonics do not control the bleeding and the uterus is firm, the nurse should anticipate the need for a provider to inspect for genital tract lacerations.

How to Approach the Question

First, identify the core of the question, which is asking for the 'major' or most common cause of PPH.
Recall the primary causes of PPH, often remembered by the '4 Ts' mnemonic: Tone, Trauma, Tissue, and Thrombin.
Evaluate the given options in the context of their prevalence. 'Atonic uterus' corresponds to 'Tone'.
Remember that uterine atony (failure of the uterus to contract) is responsible for the vast majority (around 80%) of PPH cases.
Compare this to 'Traumatic PPH', which is the second most common cause but significantly less frequent.
Conclude that 'Atonic uterus' is the single most significant or 'major' cause, making it the correct answer.

Concept Tested & Keywords

Q_QC4mVTu6UwDpyG_IT43c

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 65-80

E6 Obstetrics Williams p. 47-67

Practise the full NHM MP Staff Nurse-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.