Case history

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Multidisciplinaire richtlijn Postpartumzorg in de eerste lijn (deel 1)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022Guideline multidisciplinaire des soins postnatals dans la première ligne de soins (partie 1)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022Multidisciplinaire richtlijn Postpartumzorg in de eerste lijn (deel 2)Published by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2024Guideline multidisciplinaire des soins postnatals dans la première ligne de soins (partie 2)Published by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2024

Case history #1

A 40-year-old presents with brisk vaginal bleeding following an uncomplicated, precipitous vaginal delivery. She has a history of 7 prior normal spontaneous vaginal deliveries, with PPH following two of them. Physical examination reveals a soft, boggy uterus above the level of the umbilicus despite bimanual massage, and an otherwise intact perineum with no evidence of obstetric lacerations. There is no evidence of retained placental tissue on bimanual examination or upon inspection of the placenta. Assessment reveals an initial quantitative blood loss of 1500 mL within the first 30 minutes after delivery with ongoing bleeding, as well as a blood pressure of 90 mmHg/60 mmHg and tachycardia (130 bpm). The patient appears pale, diaphoretic, and reports dizziness and palpitations.

Case history #2

A 25-year-old presents 1 week postpartum with heavy vaginal bleeding since delivery. She reports passing multiple large fist-sized clots daily, and soaking 1-2 pads per hour for the majority of each day. She reports mild lightheadedness and dizziness since delivery, but denies fever or chills or significant abdominal pain. On physical examination, her fundus is mildly boggy and minimally tender to palpation. Pelvic examination reveals a dilated cervical os with dark clots in the vagina. Her vital signs are normal. Bedside ultrasonography reveals a 3 × 5 cm echogenic mass within the uterine fundus, and a thickened, heterogeneous endometrial stripe. Laboratory investigation reveals a haemoglobin of 87 g/L (8.7 g/dL) on full blood count.

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