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Postpartum Hemorrhage (PPH) is a leading cause of maternal death, defined as blood loss ≥1000 mL or hypovolemic symptoms within 24 hrs of birth. The primary cause is uterine atony, a failure of the myometrium to contract, resulting in a boggy uterus.

The 4 Ts of PPH:

• Tone (Atony): Restore tone via immediate bimanual fundal massage and uterotonics.
• Trauma: Lacerations or hematomas. Suspect trauma if bright red bleeding persists despite a firm uterus. Genital tears range from 1st to 4th degree (involving rectal mucosa).
• Tissue: Retained placenta (not expelled within 30 mins). Placenta Accreta Spectru ...