uw q ob- - reetuforusmle

[ArchivalUser]

A 23-year-old Caucasian female delivered a 9 lb healthy baby 30 minutes back at 37 weeks gestation. Even though the labor is prolonged, the baby and placenta was delivered spontaneously without application of forceps. Even after placental delivery, the patient appears to bleed continuously. She has lost approximately 1.5 liters of blood. IV ringers lactate is administered. Her temperature is 36.7 C (98 F), blood pressure is 100/60 mmHg, pulse is 102/min, and respirations are 18/min. Which of the following is the most appropriate next step in the management of this patient?

A) Intravenous oxytocin

B) Pelvic examination

C) Observation

D) Bimanual uterine massage

E) Uterine artery ligation
shouldn't answer be D? large baby, bleeding immediately, and most common cause of pph is uterine atony,
ans given is B

[ArchivalUser]

pelvic exam 1st to c if any segment of placenta left then bimanual msg, pt already had oxytocin after shoulder delivery, if still bleeds ligation watch out for ureter. placenta was expelled spontaneously so ut contraction is there so not atony

[ArchivalUser]

well,
I think thia is atony as pt is still bleeding
I think the ans is D
correct me if not right

[ArchivalUser]

hi

I thought again they are right B is because you first see if there are any cervical lesion or lesaretion so if they say pelvic exam its first then uterine massage

[ArchivalUser]

Thanks drlavanya and docmus! initially i thought D. spontaneus expulsion of placenta does not mean pt can't develop atony later. it is prolong labour/large baby/spontaneus delivery. so more points for atony and less likely injury. all woman gets synto at ant shoulder delivery still pph with atony occurs.
now i feel they r right it is B. looks like pt been bleeding since delivery, and may be some injury to v or cx. yesh explore pelvis. thanks for input.

[ArchivalUser]

My friend died from post partum hemorrhage ..May Sami RIP!