A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hours ago. Which of the following findings place the client at risk for postpartum hemorrhage?

Choice A rationale Vacuum-assisted delivery increases the risk of postpartum hemorrhage due to potential trauma to the birth canal and uterine atony caused by prolonged pressure or rapid extraction. The vacuum device can bruise the cervix, vagina, or perineum, leading to lacerations that bleed excessively. It can also overstretch uterine muscles, impairing their ability to contract effectively after birth. Choice B rationale A newborn weight of 2.948 kg (6 lb 8 oz) is within the normal weight range for a full-term infant. This weight does not typically pose an increased risk for postpartum hemorrhage. Larger infants (macrosomia, generally > 4 kg) are associated with higher risks due to increased uterine stretching and potential for prolonged labor or birth trauma. Choice C rationale Labor induction with oxytocin significantly increases the risk for postpartum hemorrhage, particularly due to uterine atony. Prolonged oxytocin administration can lead to desensitization of myometrial receptors, reducing the uterus's ability to contract effectively postpartum. This impaired contractility prevents compression of uterine blood vessels, resulting in excessive bleeding. Choice D rationale A history of uterine atony is a substantial risk factor for recurrent postpartum hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, accounting for a majority of cases. A prior history indicates a predisposition for the uterine musculature to fail in contracting adequately after birth, leading to uncontrolled blood loss. Choice E rationale A history of human papillomavirus (HPV) infection does not directly increase the risk of postpartum hemorrhage. HPV is a viral infection that primarily affects epithelial cells, often leading to genital warts or cervical dysplasia. It does not inherently alter uterine contractility, coagulation factors, or predispose to abnormal placental implantation, which are direct causes of hemorrhage.