Which client is at most risk for hemorrhage?

Which client is at most risk for hemorrhage?

• A. A primiparous client who delivered 4 hours ago
• B. A multiparous client who delivered 6 hours ago
• C. A multiparous client who delivered a large baby after oxytocin induction
• D. A primiparous client who delivered 6 hours ago and had epidural anesthesia

Answer: (C)

Postpartum hemorrhage is most often caused by uterine atony—when the uterus doesn’t contract firmly after the placenta is delivered. Factors that weaken the uterus’s ability to clamp down include overdistension of the uterus (such as from a large fetus) and conditions that exhaust the uterus, like induction or augmentation with oxytocin, which can lead to tachysystole and tiring of the myometrium. In this scenario, a multiparous client who delivered a large baby after oxytocin induction combines two strong risk factors: the uterus is more distended from the large baby, and induction with oxytocin increases the chance of abnormal or overly frequent contractions that can fatigue the uterus. This makes atony—and thus hemorrhage—more likely after delivery. The other options involve factors that are less likely to produce hemorrhage on their own or in combination. An educated, well-rested uterus without distension from a large fetus, or without the added effect of induction, carries a lower risk in comparison to the scenario with a large baby and induction. Epidural anesthesia can influence labor dynamics but is not as strong a standalone predictor of postpartum hemorrhage as uterine overdistension with induction.

Postpartum hemorrhage is most often caused by uterine atony—when the uterus doesn’t contract firmly after the placenta is delivered. Factors that weaken the uterus’s ability to clamp down include overdistension of the uterus (such as from a large fetus) and conditions that exhaust the uterus, like induction or augmentation with oxytocin, which can lead to tachysystole and tiring of the myometrium.

In this scenario, a multiparous client who delivered a large baby after oxytocin induction combines two strong risk factors: the uterus is more distended from the large baby, and induction with oxytocin increases the chance of abnormal or overly frequent contractions that can fatigue the uterus. This makes atony—and thus hemorrhage—more likely after delivery.

The other options involve factors that are less likely to produce hemorrhage on their own or in combination. An educated, well-rested uterus without distension from a large fetus, or without the added effect of induction, carries a lower risk in comparison to the scenario with a large baby and induction. Epidural anesthesia can influence labor dynamics but is not as strong a standalone predictor of postpartum hemorrhage as uterine overdistension with induction.