Occurs when the uterus fails to contract after the delivery of the baby and can lead to postpartum hemorrhage

• A. Placenta accreta
• B. Uterine rupture
• C. Postpartum infection
• D. Uterine atony

Answer: (D)

The main idea is that postpartum bleeding is often caused by the uterus not tightening after the baby is born. After delivery, the uterus is supposed to contract firmly to compress the blood vessels at the placental site. When it fails to contract adequately, the uterus stays soft and open, so blood continues to flow from the sites where the placenta attached. This is uterine atony, the most common cause of postpartum hemorrhage.

Clinically, you’d see a soft, “boggy” uterus on examination and heavy vaginal bleeding that may persist despite initial measures. The first response is to massage the fundus to stimulate contraction and give uterotonic meds such as oxytocin. If bleeding continues, add other agents (careful with contraindications: methylergonovine if blood pressure is a concern, carboprost if asthma, avoid misoprostol in certain settings if not needed). It’s also important to assess for retained placental tissue and remove it if present. Supportive care with fluids and blood products and using tranexamic acid when appropriate are part of the plan.

This differs from conditions like placenta accreta (bleeding related to placenta not separating normally), uterine rupture (severe pain with possible fetal distress and a tearing sensation), or postpartum infection (fever and foul-smelling discharge rather than failure to contract).