Postpartum Hemorrhage

A 32-year-old multiparous woman is evaluated for postpartum hemorrhage on postpartum day 3. She had a normal vaginal delivery 3 days ago with an estimated blood loss of 400 mL. Now she presents with heavy vaginal bleeding, passage of clots, and a tender, enlarged uterus. Hemoglobin has dropped from 11 g/dL to 8.5 g/dL. On ultrasound, there is echogenic material within the uterine cavity. What is the most common cause of late postpartum hemorrhage in this case?

A 28-year-old primigravida delivers vaginally. Within 10 minutes of delivery of the baby, she has brisk vaginal bleeding (estimated blood loss 600 mL). The placenta is still retained. What is the drug of choice for management of this postpartum hemorrhage?

A 32-year-old multiparous woman at 38 weeks gestation is admitted for planned vaginal delivery. She has a history of severe postpartum hemorrhage in her previous two deliveries, managed with oxytocin and blood transfusion. For prevention of PPH in this high-risk case, what is the drug of choice for active management of the third stage of labor?

A 28-year-old primigravida delivers a healthy 3.2 kg male infant vaginally after an 8-hour labor. The third stage of labor lasts 35 minutes. Immediately after expulsion of the placenta, the uterus is soft and boggy on abdominal examination. Vaginal bleeding is brisk, estimated at 800 mL in the first 10 minutes postpartum. Vital signs: BP 100/62 mmHg, HR 110/min, RR 22/min. Hemoglobin at admission was 11.2 g/dL. What is the most appropriate immediate next step in management?

A 32-year-old multiparous woman (G3P2) undergoes emergency cesarean section at 38 weeks for placenta previa. Intraoperatively, the lower uterine segment is thin and friable. The placenta is removed with difficulty, and the surgeon notes a small area of myometrial invasion at the placental bed. Estimated blood loss is 1200 mL. In the recovery room, 2 hours postoperatively, the patient has continuous vaginal oozing. Vitals: BP 95/58 mmHg, HR 118/min, RR 24/min. Hemoglobin is 8.5 g/dL (down from 10.8 g/dL preoperatively). Uterus is firm on palpation. What is the most likely diagnosis?