Which client should be flagged for risk of postpartum hemorrhage?

Which client should be flagged for risk of postpartum hemorrhage?

• A. A primigravida who had a spontaneous birth of preterm twins.
• B. A multigravida who delivered an 8 pound 2 ounce infant after an 8-hour labor.
• C. A multiparous client receiving magnesium sulfate during induction for severe preeclampsia.
• D. A primiparous client who had an emergency cesarean birth due to fetal distress.

Answer: (C)

Uterine atony is the leading cause of postpartum hemorrhage, and anything that reduces the uterus’s ability to contract after delivery increases that risk. Magnesium sulfate given for severe preeclampsia acts as a uterine relaxant, diminishing myometrial tone and making it harder for the uterus to clamp down after the placenta separates. That failure to contract effectively allows ongoing bleeding from the placental site, making postpartum hemorrhage more likely in this client than in the others described. While other scenarios involve factors that can contribute to bleeding (like surgical blood loss with cesarean or an overdistended uterus from multiples), the direct effect of magnesium sulfate on uterine contraction makes this patient the one at highest risk for PPH.

Uterine atony is the leading cause of postpartum hemorrhage, and anything that reduces the uterus’s ability to contract after delivery increases that risk. Magnesium sulfate given for severe preeclampsia acts as a uterine relaxant, diminishing myometrial tone and making it harder for the uterus to clamp down after the placenta separates. That failure to contract effectively allows ongoing bleeding from the placental site, making postpartum hemorrhage more likely in this client than in the others described. While other scenarios involve factors that can contribute to bleeding (like surgical blood loss with cesarean or an overdistended uterus from multiples), the direct effect of magnesium sulfate on uterine contraction makes this patient the one at highest risk for PPH.