A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb neonate. Her labor was unusually long and required oxytocin augmentation. The nurse should stay alert for which postpartum complication?

A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb neonate. Her labor was unusually long and required oxytocin augmentation. The nurse should stay alert for which postpartum complication?

• A. Uterine atony.
• B. Infection.
• C. Preeclampsia.
• D. Postpartum hemorrhage due to lacerations.

Answer: (A)

Uterine atony is the postpartum complication to vigilantly monitor here. After a long, difficult labor with forceps, a large baby, and oxytocin augmentation, the uterus can become overstretched and fatigued, making it hard for it to contract effectively after the placenta is delivered. When the uterus fails to contract, the uterine vessels aren’t compressed, leading to heavy postpartum bleeding—the most common cause of postpartum hemorrhage. Recognizing a boggy, noncontracting fundus and copious lochia is key. Addressing it promptly with fundal massage and appropriate uterotonic medications helps restore tone and reduce hemorrhage risk. While infection, preeclampsia, or bleeding from lacerations can occur postpartum, they’re less directly tied to the scenario’s risk factors, making atony the most likely concern in this context.

Uterine atony is the postpartum complication to vigilantly monitor here. After a long, difficult labor with forceps, a large baby, and oxytocin augmentation, the uterus can become overstretched and fatigued, making it hard for it to contract effectively after the placenta is delivered. When the uterus fails to contract, the uterine vessels aren’t compressed, leading to heavy postpartum bleeding—the most common cause of postpartum hemorrhage.

Recognizing a boggy, noncontracting fundus and copious lochia is key. Addressing it promptly with fundal massage and appropriate uterotonic medications helps restore tone and reduce hemorrhage risk. While infection, preeclampsia, or bleeding from lacerations can occur postpartum, they’re less directly tied to the scenario’s risk factors, making atony the most likely concern in this context.