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HardRural & Remote MedicinePrimary postpartum haemorrhageau-amcau-acem

A 29-year-old woman, 2 hours postpartum after a vaginal delivery in a small rural hospital, develops heavy vaginal bleeding with estimated blood loss of 900 mL. Uterus feels boggy on palpation. Blood pressure is 95/60 mmHg and heart rate 110 beats/min. The placenta has been delivered intact. What is the most appropriate immediate management?

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