4 T's — Postpartum hemorrhage causes
Differential diagnosis for PPH
Mnemonic device
4 T's (in order of frequency)
Mapping
Tone (70%)
Uterine atony — soft, boggy uterus. Treat: massage + oxytocin + 2nd-line uterotonics + balloon
Trauma (20%)
Cervical/vaginal laceration, uterine rupture, hematoma. Treat: surgical inspection + repair
Tissue (10%)
Retained products, placenta accreta. Treat: manual extraction or D&C; accreta → hysterectomy
Thrombin (1%)
Coagulopathy — DIC, anticoagulated, AFE-related, HELLP. Treat: products + TXA
Clinical note: Atony is the most common — start there. But don't miss trauma in operative delivery (forceps, vacuum, breech) — bleeding despite firm uterus = look for laceration.