Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with excessive vaginal bleeding following delivery. Estimated blood loss (EBL) is [amount] mL. Onset of hemorrhage occurred [time] post-delivery. Associated symptoms include lightheadedness, tachycardia, and hypotension. Uterine fundus is [firm/boggy]. Presence of clots or tissue noted. No prior history of coagulopathy.
Clinical Examination Findings
Vitals: BP [value], HR [value], O2 sat [value]. General: Patient appears pale, diaphoretic, and anxious. Abdominal/Pelvic Exam: Uterine fundus is [boggy/firm], displaced [position]. Vaginal inspection reveals [active bleeding/lacerations/hematoma]. Perineal assessment shows [intact/laceration degree]. Cervical exam indicates [status].
Treatment Protocol
Immediate management: 1. Fundal massage and bimanual compression. 2. IV access (two large-bore cannulas) and fluid resuscitation. 3. Uterotonic agents: Oxytocin [dose], Methylergonovine [dose], or Misoprostol [dose]. 4. Inspection for lacerations and retained products of conception. 5. Type and cross-match for blood transfusion if indicated. 6. Monitor vitals and urine output.