After birth

A 31 year old primipara at full term delivered a healthy baby vaginally, following an uncomplicated labor. The placenta was delivered completely, following which prophylactic oxytocin was administered. An episiotomy was not performed.

When reassessed 30 minutes after delivery, she was found to be bleeding heavily.

Her pregnancy had been uneventful, and her medical and surgical histories were unremarkable.

Select Relevant Investigations
Group & Cross-match Blood

Performed

Blood group: A+ve
4 pints of blood cross-matched
Coagulation screen

Performed

INR: 1.0 (normal: 0.9 - 1.3)
APTT: 32s (normal: 24 - 35 in third trimester)
TT: 14s (normal: 13 - 15)
S. Fibrinogen: 300 mg/dl (normal: 200 - 400)
Full Blood Count

Performed

WBC/DC: 6,300/mm3
Hb: 9.7 mg/dl
Platelets: 330,000/mm3
Bedside Ultrasound Abd+Pelvis

Performed

There is no evidence of retained intrauterine tissue. There is no free fluid in the abdomen.

Select Relevant Management
Transfuse Blood
Mifepristone
Oxytocin infusion
IV Antibiotics