Description #
Case – Post partum hemorrhage
Learning Objectives #
– learn the clinical presentation, physical exam findings with post partum hemorrhage
– develop a system for treating post partum hemorrhage
Post Partum Bleed #
You are a 3rd year medical student and you’re on call on L & D for the very first time. You have just figured out how your pager works when you get your first page. You decide to call back right away and you hear from the nurse.
“Ms X is a 38 year old G5P5 that just delivered 30 minutes ago. Dr. X just left the hospital but now she’s starting to feel dizzy and I just took her blood pressure and its pretty low, 80 / 50. She’s usually 110 / 75.”
What else do you want to know from the RN?
On the way to the room #
You think that this patient might be having a post partum hemorrhage so you want to know about her hemodynamic state so you ask:
- What are the rest of the vitals?
- What is her heart rate?
- What is her O2 saturation?
- Is she still talking?
- What colour is she?
- Are her extremities cool or warm?
You start thinking about some of the risk factors of PPH
- Does she have a fever?
- What was the delivery like, was it very fast or very slow?
- Did she have a vaginal operative delivery?
- Was her perineum intact?
In the Room #
You enter the room and first off talk to the patient.
When you talk to the patient she says “I’m not feeling very well, I feel like I want to throw up” She then throws up, just missing your shoes.
You decide to move onto the physical exam and
PEx
What do you look for
- vitals
- inspection, mom, placenta
- palpation abdomen
- inspection of perineum, vagina, cervix
Investigations
lab work
- cbc, esp. platelets
- INR and PTT