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Postpartum hemorrhage due to uterine atony — USMLE Step 2 CK MCQ

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EasyObstetrics & GynecologyPostpartum hemorrhage due to uterine atonyUSMLE Step 2 CK

A 25-year-old Hispanic woman comes to the hospital because of pelvic symptoms or pregnancy-related concerns. History and focused examination are notable for heavy postpartum bleeding with boggy enlarged uterus after delivery. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Laboratory studies show hemoglobin 8.4 g/dL, platelets 230,000/mm3, and creatinine 0.9 mg/dL unless otherwise specified. Which of the following is the most likely diagnosis?

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Correct answer: A — Postpartum hemorrhage due to uterine atony

The vignette describes Postpartum hemorrhage due to uterine atony, supported by heavy postpartum bleeding with boggy enlarged uterus after delivery. Postpartum hemorrhage due to uterine atony is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ACOG Practice Bulletin on Postpartum Hemorrhage