After delivery with six living children, an infusion of lactated Ringer's solution with 10 units of Pitocin is ordered. The nurse understands this is indicated for this client because:

• A. Retained placental fragments
• B. This was an extramural birth
• C. She had a precipitate birth
• D. Multigravidas are at increased risk for uterine atony

Answer: (D)

Promoting uterine contractions after delivery to prevent hemorrhage is the main idea here. Oxytocin (Pitocin) given with IV fluids helps the uterus stay firm and compress blood vessels, reducing the risk of postpartum bleeding. This patient has six living children, a condition called grand multiparity, which is a major risk factor for uterine atony because the uterus can be overdistended or fatigued from prior pregnancies. When the uterus doesn’t clamp down effectively, heavy bleeding can occur, so starting Pitocin with IV fluids aims to maintain uterine tone and prevent atony.

Retained placental fragments would cause ongoing bleeding that often requires intervention beyond prophylactic oxytocin; extramural or precipitate birth aren’t the primary reasons for this specific infusion, so they don’t explain why Pitocin is ordered in this scenario.