42 weeks' gestation delivers a 4000-g (8-lb
13-oz) newborn after induction of labor with
oxytocin. The first and second stages of labor
lasted 14 and 3 hours, respectively. A midline
episiotomy was done, and the placenta
appeared to be intact. Ten minutes after
delivery, she has copious vaginal bleeding
estimated to be 500 mL over a 5-minute
period; the fundus is soft and boggy. Which of
the following is the most likely cause of the
hemorrhage?
(A) Cervical laceration
(B) Disseminated intravascular
coagulation
(C) Retained placental tissue
(D) Uterine atony
(E) Uterine inversion
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