Question

A 37-year-old G4P3 woman presents in labor at term. Her medical history and prenatal course are uncomplicated. She delivers a 3500 gram infant spontaneously after oxytocin augmentation of labor. Immediately postpartum, there is excessive bleeding greater than 2000 cc. She has an IV in place. There are no lacerations and the uterus is found to be boggy. Which of the following is the most appropriate next step in the non-operative management of this patient?

A. Intravenous misoprostol
B. Intramuscular misoprostol
C. Intravenous prostaglandin F2-alpha
D. Intramuscular prostaglandin F2-alpha
E. Intravenous oxytocin push

Answer 1

In the case of a G4P3 woman with excessive postpartum bleeding and a boggy uterus, the most appropriate non-operative management step would be an intravenous oxytocin push to stimulate uterine contractions and control the bleeding.

Step-by-step explanation:

A 37-year-old G4P3 woman presents in labor at term and delivers a 3500-gram infant spontaneously after oxytocin augmentation. Postpartum, she experiences excessive bleeding >2000cc with a boggy uterus and no lacerations. In the non-operative management for this scenario, the most appropriate next step would be E. Intravenous oxytocin push. This is because the excessive bleeding is likely due to uterine atony, where the uterus fails to contract after childbirth. Oxytocin is already well known to increase the strength of uterine contractions during labor and can help to stop the bleeding by causing the uterus to contract in the postpartum period. The synthetic form of oxytocin, Pitocin, can also be used to maintain labor if there's a failure to progress, as in the case with Janine who was 41 weeks pregnant.