OBSadvanced
A patient continues to bleed despite a firm uterus and a complete placenta. Explain how the 4 Ts framework guides the next assessment.
Answer
Tone and Tissue become less likely explanations, so promptly examine for Trauma, including vulvovaginal, cervical, or uterine injury, and assess for Thrombus/coagulopathy such as DIC. Continue reassessing because causes can coexist.
Explanation
A firm uterus makes atony less likely, and a complete placenta reduces the likelihood of retained tissue, but neither finding excludes other causes. The 4 Ts direct attention to lacerations, haematoma, rupture, and coagulopathy. **Key takeaway:** Persistent bleeding requires a renewed, complete search for cause.\n\n**Glossary:** **Coagulopathy**: impaired blood clotting.
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