Which postpartum complication is characterized by heavy vaginal bleeding with a soft uterus and fundus that is not well contracted?

• A. Endometritis
• B. Postpartum hemorrhage due to uterine atony
• C. Retained placenta
• D. Uterine inversion

Answer: (B)

Uterine atony is the situation where the uterus doesn’t stay firm after delivery, so it can’t adequately clamp down on the blood vessels at the placental site. When the uterus is soft and boggy and won’t contract well, the placental blood vessels remain open, leading to heavy vaginal bleeding despite no obvious lesion or tear. That combination—a heavy bleed plus a soft, poorly contracted uterus—is the classic clue that postpartum hemorrhage is due to uterine atony.

Understanding the contrast helps solidify the concept: infection like endometritis presents with fever, uterine tenderness, and foul-smelling lochia rather than a simply boggy uterus with heavy bleeding. Retained placental tissue can also cause heavy bleeding, but the uterus may not feel the same boggy tone and often involves tissue remnants in the uterus that prevent normal involution. Uterine inversion presents with a dramatic change where the uterus turns inside out and is not felt in its normal location, accompanied by severe distress rather than the straightforward boggy fundus described here.

In practice, management centers on promptly stimulating contraction and controlling hemorrhage: fundal massage combined with uterotonic medications (such as oxytocin and others as appropriate), rapid assessment of the mother’s stability, and preparation for possible blood product administration.