Commonest cause of postpaum hemorrhage In multipara is:
**Core Concept**
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, defined as the loss of more than 500 mL of blood after delivery. In multiparous women, the risk of PPH is increased due to factors such as uterine atony, retained placental tissue, and lacerations.
**Why the Correct Answer is Right**
The correct answer is **retained placental tissue**. This is because retained placental tissue can lead to continued bleeding from the placental bed, which can be difficult to control. The placental tissue can be retained due to factors such as uterine atony, fetal macrosomia, or improper manual removal of the placenta. The bleeding can be exacerbated by the presence of clotting factor inhibitors in the placental tissue, making it challenging to achieve hemostasis.
**Why Each Wrong Option is Incorrect**
* **Option A:** Uterine atony is a common cause of PPH, but it is not the most common cause in multiparous women. Uterine atony refers to the failure of the uterus to contract effectively after delivery, leading to uncontrolled bleeding.
* **Option B:** Lacerations are a possible cause of PPH, but they are not the most common cause in multiparous women. Lacerations can occur during delivery, particularly if the perineum is not adequately protected during the pushing stage.
* **Option D:** Coagulopathy is a rare cause of PPH, and it is not the most common cause in multiparous women. Coagulopathy refers to a disorder of blood clotting, which can lead to excessive bleeding during delivery.
**Clinical Pearl / High-Yield Fact**
In multiparous women, it is essential to inspect the placental bed thoroughly after delivery to ensure that all placental tissue has been removed. This can be achieved by using a combination of manual and instrumental techniques, such as the use of a sponge stick or a curette.
**Correct Answer: C. Retained placental tissue**