Upside Down

Pregnancy, Childbirth, & the Puerperium

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This lady has developed heavy vaginal bleeding in association with severe abdominal pain, a few hours following delivery.\n\nExamination reveals the presence of pallor, tachycardia, a prolonged capillary refill time (CRFT), and a borderline blood pressure; i.e. she appears to be in grade II hypovolemic shock.\n\nGrade II hypovolemic shock typically occurs when between 750 to 1500 ml of blood has been lost; note that loss of more than 500 ml of blood within the first 14 hours of delivery is categorized as a primary postpartum hemorrhage (PPH).\n\nPPH is a life-threatening obstetric emergency; prompt management is essential for a good outcome; this involves four steps which should be performed in parallel.\n\nThe first step is immediate resuscitation"}]}

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