A 37-Year-Old Woman, Gravida 4, Para 3, at 35 Weeks

A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor. She has had no prenatal care. Two years ago, she delivered her 3rd child by uncomplicated cesarean delivery. The patient appears in acute distress. Her pulse is 98/min, respirations are 15/min, and blood pressure is 130/80 mm Hg. The abdomen is nontender and contractions are felt. One hour following vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. A firm, nontender uterine fundus is palpated at the level of the umbilicus. 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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