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Quick, let's get on with it.

Imagine you are at work and the ED charge nurse gives you the heads up that there's a 24-year-old

woman coming in who is two days postpartum with severe vaginal

bleeding and a BP of 70 on 40. ETA is five minutes. You prepare your team, your gear, and yourself.

Let's talk postpartum hemorrhage. Take it away, Swami.

Postpartum hemorrhage isn't a common presentation, but I think it's one that we do have to be comfortable with. When precipitous deliveries occur in the emergency department, we often focus on the

baby, but we can't lose focus on the other patient, the mom. Key point number one is in recognizing postpartum hemorrhage.

Typically, we define it as more than 500 ccs of bleeding after birth, but sometimes that doesn't

all happen at one time. It's not this brisk bleeding of 500 ccs. It might be oozing over time.

It can be difficult for us to really assess how much blood loss there's been,

and we can't rely on hemodynamic instability.

These are young patients, and that's going to be a late finding.

The rule of thumb that I use is to simply look for more bleeding than you expect with a normal

delivery.

Once you recognize that you're dealing with postpartum hemorrhage, you want to get your

consultants on board since operative control isn't uncommon. Obviously, this means OBGYN. If you have no

OB in house, then general surgery can be extremely helpful. And if you've got no surgical backup,

then you really need to get that transfer moving early so you can get the patient off to definitive

...