Case Scenario for the Postpartum Hemorrhage
26-year-old G2P1 underwent cesarean at 11 pm for prolonged second stage and arrest of descent, after a 24-hour labor with dysfunctional labor, augmentation, and a 3-hour second stage. Birthweight was 4800 grams. Pre-op hematocrit was 37%. During surgery, blood loss reported to be 1000 cc and an extension of the transverse uterine incision was sutured while extending in the left broad ligament. Patient is now in the recovery room at midnight and complaining of abdominal pain. BP 120/60, pulse 120. Patient passing
moderate amount of blood clots. Oxytocin running IV (125 cc/hr of D5RL with 20 U oxytocin). At 12:30 am, patient passing more clots. BP 70/40, pulse 150, urine output less than 20 cc since surgery. Abdomen seems distended.