Obstetrics & Gynecology

Answer 1 Perform a pelvic examination to assess for uterine atony and the extent of the episiotomy. In cases where there is acute and profuse bleeding following a delivery, immediate evaluation of the episiotomy, lacerations (if any), and a bimanual examination of the uterus is required.1 Most postpartum hemorrhage cases are due to uterine atony. The uterine fundus is not firm, and the uterus in whole is soft. Observation alone is an inappropriate clinical option. Cesarean hysterectomy is required if medical management fails. If there is a concern of retained products of conception, then a manual intrauterine evaluation takes precedence over an ultrasound examination due to the acuity of the situation. A complete blood count can be done afterwards; it will not help with the acute circumstance. REFERENCE 1. Gilstrap LC, Ramin SM. Postpartum hemorrhage. Clin Obstet Gynecol 1994;37:824–30. Click here to return to the questions

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