Which among the following is the commonest cause of postpaum haemorrhage in multipara?
Postpaum hemorrhage is defined as the loss of 500 mL of blood or more after completion of the third stage of labor. Blood lost during the first 24 hours after delivery is early postpaum hemorrhage; blood lost between 24 hours and 6 weeks after delivery is late postpaum hemorrhage. Causes of postpaum hemorrhage include uterine atony, obstetric lacerations, retained placental tissue, and coagulation defects. Atony is the most common cause of postpaum hemorrhage (50% of cases). Predisposing causes include, Excessive manipulation of the uterus General anesthesia (paicularly with halogenated compounds) Uterine overdistension (twins or polyhydramnios) Prolonged labor Grand multiparity Uterine leiomyomas Operative delivery and intrauterine manipulation Oxytocin induction or augmentation of labor Previous hemorrhage in the third stage Uterine infection Extravasation of blood into the myometrium (Couvelaire uterus) Intrinsic myometrial dysfunction Ref: Poggi S.B. (2013). Chapter 21. Postpaum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
Fibroid
Retained placenta
Uterine perforation
Uterine atony