What is the leading cause of postpartum hemorrhage in the fourth stage according to best practices?

Uterine atony is recognized as the leading cause of postpartum hemorrhage in the fourth stage of labor due to its significant impact on the uterus's ability to contract effectively after delivery. When the uterus does not contract well, it fails to constrict the blood vessels that have been torn during childbirth, leading to excessive bleeding. This can occur immediately after delivery or within the first few hours and is a critical concern for maternal health.

The condition is particularly common because of factors such as overdistension of the uterus (due to a large baby, multiple pregnancies, or excessive fluid), prolonged labor, and use of certain medications that can interfere with uterine tone. In clinical practice, effective management of uterine atony is essential; it often includes interventions such as administering oxytocin, performing uterine massage, and, if necessary, surgical procedures to control the hemorrhage.

Understanding the role of uterine atony is crucial for midwives and healthcare providers as they monitor for signs of hemorrhage and implement timely interventions to ensure the safety and health of the mother postpartum.