Clinical evaluation of postpartum hemorrhage

A. Uterine atony is the most common cause of postpartum hemorrhage. Conditions associated with uterine atony include an overdistended uterus (eg, polyhydramnios, multiple gestation), rapid or prolonged labor, macrosomia, high parity, and chorioamnionitis.

B. Conditions associated with bleeding from trauma include forceps delivery, macrosomia, precipitous labor and delivery, and episiotomy.

C. Conditions associated with bleeding from coagulopathy and thrombocytopenia include abruptio placentae, amniotic fluid embolism, preeclampsia, coagulation disorders, autoimmune thrombocytopenia, and anticoagulants.

D. Uterine rupture is associated with previous uterine surgery, internal podalic version, breech extraction, multiple gestation, and abnormal fetal presentation. High parity is a risk factor for both uterine atony and rupture.

E. Uterine inversion is detected by abdominal vaginal examination, which will reveal a uterus with an unusual shape after delivery.

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