If vaginal bleeding persists after delivery and the uterus is firmly contracted, what should be suspected?

In the scenario where vaginal bleeding continues after delivery despite the uterus being firmly contracted, the most likely suspicion is a laceration of the genital tract. This condition can occur during childbirth due to trauma to the vagina, cervix, or perineum. When the uterus is properly contracted, it suggests that uterine atony—failure of the uterus to contract effectively—is likely not the cause of the bleeding.

Persistent vaginal bleeding with a firm uterus indicates that the source of the hemorrhage may not be from the uterus itself, but rather from lacerations that may have occurred during labor or delivery. Lacerations can lead to significant blood loss and may be difficult to identify without a thorough examination. This understanding highlights the importance of assessing for lacerations when active bleeding occurs following delivery, as prompt identification and management are crucial in preventing further complications.

Other options such as coagulopathy and retained placenta could also contribute to vaginal bleeding; however, the specific detail that the uterus is contracting firmly directs the focus toward potential genital tract injuries instead. Uterine atony is ruled out due to the firm contraction of the uterus, emphasizing the need to investigate other potential causes like lacerations.