Which of the following is a risk factor for postpartum hemorrhage in a client who delivered vaginally?

• A. Spontaneous labor
• B. Induction with prostaglandins
• C. Oxytocin-induced labor
• D. Prolonged pregnancy

Answer: (C)

Inducing labor with oxytocin can raise the risk of postpartum hemorrhage because it can cause the uterus to contract too frequently or too forcefully (tachysystole). When contractions are excessive, the uterus can become exhausted and fail to clamp down effectively after the baby is born. A soft, uncontracted uterus allows bleeding from the placental site to continue, leading to heavy vaginal bleeding after delivery. Spontaneous labor usually follows a more natural contraction pattern and is less likely to drain the uterine energy stores in the same way, and prolonged pregnancy is less directly tied to postpartum bleeding than the effects of inducing labor with oxytocin. Induction with prostaglandins can also increase contraction intensity, but the use of oxytocin to start labor is a well-recognized risk factor for postpartum hemorrhage due to potential for uterine over-stimulation and subsequent atony.