Which one of the following is a major cause for atonic postpartum haemorrhage?

SCTIMST Staff Nurse - 2015 (Set-A)

Obstetrics & Gynaecology

Medium

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

Retained products of conception, such as placental fragments or blood clots, are a primary cause of atonic postpartum hemorrhage (PPH).
This corresponds to the 'Tissue' category in the classic '4 Ts' mnemonic for PPH causes (Tone, Tissue, Trauma, Thrombin).
The presence of retained tissue physically obstructs the myometrium, preventing the uterus from contracting and retracting effectively after delivery.
This failure of the uterus to contract is known as uterine atony ('Tone'), which is the most common immediate cause of PPH. Therefore, retained tissue is a major underlying reason for atonic PPH.

Option A: While uterine infection (chorioamnionitis) is a recognized risk factor for uterine atony, it is not considered as direct or mechanical a cause as retained products. Infection is often a contributor rather than the primary cause in the immediate postpartum period.
Option C: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that can have various effects on pregnancy but is not a direct or common cause of uterine atony.
Option D: Jaundice is a clinical sign of hyperbilirubinemia, indicating liver or red blood cell issues. It is not a cause of uterine bleeding.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of Atonic Postpartum Hemorrhage (PPH) as background academic context rather than a clinical decision trigger.
A critical nursing responsibility after delivery is the meticulous inspection of the placenta and membranes to ensure they are complete. This single action can prevent a life-threatening hemorrhage.
If PPH due to atony is suspected, the first nursing actions are to call for help, begin vigorous fundal massage to stimulate contraction, ensure IV access, and administer uterotonic medications like oxytocin as per protocol.
Patient safety is paramount. Underestimating blood loss is common. Quantitative blood loss measurement and close monitoring of vital signs are essential to recognize and respond to PPH early.

How to Approach the Question

First, identify the key terms in the question: 'atonic postpartum haemorrhage' and 'major cause'. This means you are looking for a primary reason why the uterus would fail to contract after birth, leading to bleeding.
Recall the common causes of postpartum hemorrhage. The '4 Ts' mnemonic (Tone, Tissue, Trauma, Thrombin) is the standard framework for this.
Analyze the relationship between the '4 Ts'. Uterine atony ('Tone') is the most common problem, but the question asks for a cause for the atony.
Evaluate each option against the '4 Ts' framework:
'Retained products' fits directly into the 'Tissue' category. Ask yourself: Can retained tissue cause the uterus to be atonic? Yes, it physically blocks contraction.
'Infection' is a risk factor for atony but is less direct than a physical blockage.

Concept Tested & Keywords

Concept Tested: Causes of Atonic Postpartum Hemorrhage (PPH)
Stem keywords: atonic postpartum haemorrhage, major cause
Lead-in keywords: Which one
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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

E6 Obstetrics Williams p. 45-64