Which one is the main cause of postpartum hemorrhage?

Appeared in: UPPSC-2021

Explanation

Uterine atony is the failure of the myometrium (uterine muscle) to contract effectively after childbirth.
It is the leading cause of primary postpartum hemorrhage (PPH), accounting for approximately 80% of cases.
After the placenta detaches, the uterine muscles must contract to constrict the spiral arteries and prevent excessive bleeding from the placental site.
In uterine atony, this contractile mechanism fails, resulting in continuous and potentially life-threatening blood loss.

Option B: Trauma to the genital tract (e.g., cervical, vaginal, or perineal lacerations) is a significant cause of PPH but is not the most common one.
Option C: Disorders of blood coagulation (Thrombin issues) are the least common cause of PPH, accounting for only about 1% of cases.
Option D: Retained placental tissue is an important cause of PPH but is less common than uterine atony.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Postpartum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
Rapid identification of the cause of PPH is a critical nursing skill. The first step in management is assessing uterine tone by palpating the fundus. A soft, 'boggy' uterus indicates atony.
The primary nursing intervention for a boggy uterus is immediate and vigorous fundal massage to stimulate contraction, while simultaneously calling for help and preparing uterotonic medications.
Patient safety depends on a swift, coordinated team response to control hemorrhage and prevent progression to hypovolemic shock.

How to Approach the Question

Identify the core question: It asks for the 'main cause' of postpartum hemorrhage.
This implies you need to recall the most frequent or common etiology from a list of known causes.
Access your knowledge of obstetrical emergencies, specifically the causes of PPH.
Recall the '4 Ts' mnemonic: Tone, Trauma, Tissue, and Thrombin.
Remember the relative frequency of each 'T'. Tone (uterine atony) is by far the most common, responsible for the vast majority (70-80%) of cases.
Select 'Atonic uterus' as it corresponds to 'Tone' and is the most prevalent cause.

Concept Tested & Keywords

Concept Tested: Causes of Postpartum Hemorrhage (PPH)
Stem keywords: postpartum hemorrhage, main cause
Lead-in keywords: Which one
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 65-79

E6 Obstetrics Williams p. 47-67

Practise the full UPPSC-2021

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