A grand multipara following a full term normal delivery went into shock. On examination the uterus was found to be flabby and became hard on massaging. What is the most probable diagnosis?

This patient might have developed post paum hemorrhage which is a life threatening emergency. Complications of PPH includes maternal moality, shock, transfusion reactions, peurperal sepsis, failing lactation, pulmonary embolism, thrombosis and thrombophlebitis. Late sequale includes Sheehans syndrome or diabetes insipidus. 80% of PPH is caused by uterine atony and remaining 20% could be traumatic. Causes of uterine atony includes: Grand multipara Overdistention of uterus Malnutrition and anemia Antepaum hemorrhage Prolonged labour Anaesthesia Augmentation of labour by oxytocin Persistent uterind distention Malformation of uterus Uterine fibroid Mismanaged 3rd stage of labour Constriction ring Precipitate labour