Which of the following findings place a client who had a vaginal delivery 3 hr ago at risk for postpartum hemorrhage? (Select all that apply)

Choice A reason: A newborn weight of 2.948 kg is normal and not a risk factor for postpartum hemorrhage. Large-for-gestational-age infants (>4 kg) increase uterine overdistension, impairing contraction and causing bleeding. This weight does not strain uterine muscle tone, maintaining normal postpartum hemostasis, per obstetric physiology. Choice B reason: Uterine atony, failure of the uterus to contract post-delivery, is a major cause of postpartum hemorrhage. Ineffective contractions prevent hemostasis at placental separation sites, leading to excessive bleeding. Myometrial fatigue or previous atony increases risk, as poor uterine tone disrupts clotting cascades, necessitating vigilant monitoring and oxytocic intervention. Choice C reason: Vacuum-assisted delivery increases postpartum hemorrhage risk due to potential uterine or cervical trauma. Instrumentation can cause lacerations or hematomas, disrupting hemostasis. Tissue trauma triggers local bleeding, and prolonged labor may weaken uterine contractions, impairing clot formation at the placental site, per obstetric complication studies. Choice D reason: History of human papillomavirus (HPV) does not increase postpartum hemorrhage risk, as it affects cervical epithelium, not uterine contractility or hemostasis. HPV is linked to cervical cancer, not obstetric complications. Postpartum bleeding stems from uterine or traumatic factors, making HPV irrelevant to hemorrhage pathophysiology in the postpartum period. Choice E reason: Labor induction with oxytocin increases postpartum hemorrhage risk, as prolonged exposure may desensitize myometrial receptors, leading to uterine atony. Ineffective contractions post-delivery impair hemostasis at the placental site, causing bleeding. Oxytocin’s effect on uterine muscle tone requires careful monitoring to prevent excessive blood loss, per obstetric pharmacology.