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1.) What is the diagnosis?

The diagnosis for this patient is postpartum hemorrhage. Postpartum hemorrhage is defined as a blood loss of 1,000 mL or more or signs and symptoms of hypovolemia within the first 24 hours after delivery and up to 12 weeks postpartum, regardless of method of delivery (vaginal or cesarean) (Watkins & Stem, 2020). Postpartum hemorrhage is classified as primary, occurring within 24 hours of delivery, or secondary, occurring after the first 24 hours.

2.) What is your immediate management plan?

Postpartum hemorrhage (PPH) is the leading cause of global maternal mortality and accounts for approximately one-quarter of all maternal deaths worldwide (McLintock, 2020). It appears that the patient is experiencing hypovolemic shock, therefore, the immediate management plan for this patient should be aggressive and swift to prevent further decline. The healthcare team should simultaneously start intravenous access, place a urinary catheter, collect a complete blood count (CBC) and a basic metabolic panel (BMP), and collect a type and screen. Further management of this patient recommended by Kumar & Gaiwal (2022), includes initiating uterine contractions, such as uterine massage, bimanual uterine compression, drugs like uterotonics, tranexamic acid, IV fluids, and if needed calcium should be given. Kumar & Gaiwal (2022) further states uterotonics like oxytocin, PGF2 alfa, methyl ergometrine, or misoprostol may be tried in that order. Packed red blood cells, fresh frozen plasma, fibrinogen, and platelets should also be given to the patient, with the amount dependent on the hospitalâ€™s protocols.

3.) What is your subsequent management plan?

Subsequent management plans for this patient include evaluation of initial interventions, pain management, and venous thromboembolism (VTE) prophylaxis. If initial interventions fail, surgery may be required. IV antibiotic should also be given to this patient since the open cervix places this patient at increased risk of infection.

4.) Should an ultrasound be ordered?

Yes, ultrasound should be ordered to help accurately identify retained products of conception and to adequately view pelvic organs for any abnormalities.

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