Upside Down

A 25 year old primipara presents at term for delivery; her pregnancy has been uncomplicated so far, and her medical and surgical histories are unremarkable.

She delivers a healthy baby vaginally, followed by the complete placenta. Prophylactic oxytocin is administered.

Six hours later, she starts to complain of severe lower abdominal pain and heavy vaginal bleeding.

Select Relevant Investigations
Ultrasound Abdomen & Pelvis

Performed

You realize that this would waste valuable time.
Full Blood Count

Performed

WBC/DC: 8,000/mm3 (4,600-11,000)
Hb: 9.0 g/dL (11-18)
Platelets: 380,000/mm3 (150,000-400,000)
Coagulation Profile

Performed

INR: 1.0 (0.9 - 1.3)
APTT: 28 sec (24 - 35)
TT: 12 sec (12-14)
Crossmatch Blood

Performed

Four pints of blood are crossmatched.

Select Relevant Management
Blood Transfusion
Manual Reduction
Tocolytics
Internal Iliac Artery Ligation