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


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


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


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


Four pints of blood are crossmatched.

Select Relevant Management
Blood Transfusion
Manual Reduction
Internal Iliac Artery Ligation