You are taking care of a patient in the fourth stage of labor following a vaginal delivery who has uterine atony due to retained placental fragments. Her QBL thus far is 950 ml. She is a G5 P5 LS and has been diagnosed with superimposed preeclampsia. She has been on magnesium sulfate during the induction, which is paused at the moment. Her vital signs are as follows: HR 110, BP 80/50, temp 99.1, SpO2 is 97.

What is the most appropriate next step in management?

1. Administer oxytocin
2. Administer misoprostol
3. Administer methylergonovine
4. Perform manual removal of placenta

Question

12-12-2024
Health

High School

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You are taking care of a patient in the fourth stage of labor following a vaginal delivery who has uterine atony due to retained placental fragments. Her QBL thus far is 950 ml. She is a G5 P5 LS and has been diagnosed with superimposed preeclampsia. She has been on magnesium sulfate during the induction, which is paused at the moment. Her vital signs are as follows: HR 110, BP 80/50, temp 99.1, SpO2 is 97.

What is the most appropriate next step in management?

1. Administer oxytocin
2. Administer misoprostol
3. Administer methylergonovine
4. Perform manual removal of placenta

Answer :

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KathrynJanice KathrynJanice · Answer 1 · 2025-03-05T23:31:34-05:00

The most appropriate next step in management for a patient with uterine atony and retained placental fragments after childbirth is to perform manual removal of placenta. This helps in facilitating uterine contraction and stopping the bleeding. The correct option is 4) Perform manual removal of placenta.

The patient in this scenario is experiencing uterine atony with a significant quantity blood loss of 950ml after childbirth, alongside signs of hemodynamic instability, as indicated by a low blood pressure (BP 80/50). Given the patient's state of superimposed preeclampsia and recent treatment with magnesium sulfate, the use of methylergonovine is contraindicated due to its potential to exacerbate hypertension. Of the options provided, the most appropriate next step in management would be to perform manual removal of placenta. This is because retained placental fragments are a common cause of uterine atony, and manual exploration can identify and remove these fragments to facilitate uterine contraction and cessation of bleeding. After removal, administration of uterotonic agents like oxytocin can be considered to further encourage uterine contractions and resolve the atony. The correct option is 4) Perform manual removal of placenta.