A 36-Year-Old Woman, Gravida 2 Para 1, at 38 Weeks

A 36-year-old woman, gravida 2 para 1, at 38 weeks gestation comes to the hospital in active labor, dilated to 10 cm.  She has received no prenatal care this pregnancy.  Her prior pregnancy resulted in an uncomplicated cesarean delivery.  On admission, temperature is 36.7 C (98.1 F) , blood pressure is 132/84 mm Hg, and pulse is 94/min.  The patient precipitously delivers an infant weighing 4.1 kg (9 lb 2 oz) .  After delivery of the infant, small placental fragments are removed in pieces via manual extraction.  Profuse vaginal bleeding occurs, and intravenous lines are placed.  Uterotonic medications are administered and vigorous uterine massage is performed.  The uterine fundus is firm, but the bleeding continues.  Which of the following is the most likely cause of this patient's ongoing vaginal bleeding?

A) Full-thickness rupture of the uterine myometrium
B) Hypertension-induced placental detachment
C) Inadequate uterine contraction
D) Infection of the uterus and placental membranes
E) Placental invasion into the uterine myometrium

Correct Answer:

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