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Secondary postpartum haemorrhage — RCPSC EM MCQ

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HardOB/GYN emergenciesSecondary postpartum haemorrhageRCPSC EM

Ten days after delivery, a patient has heavy vaginal bleeding, BP 88/46 mmHg, tachycardia, uterine tenderness and vascular intrauterine material on ultrasound. Which next action provides the necessary haemorrhage source control?

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Correct answer: A — Resuscitate and arrange urgent obstetric uterine evacuation

The best answer is “Resuscitate and arrange urgent obstetric uterine evacuation”. This is secondary postpartum haemorrhage with shock and probable retained products, with infection also requiring assessment. Immediate resuscitation, senior obstetric involvement, blood-product readiness and urgent uterine source control are required. Iron, outpatient imaging and oral antibiotics alone delay life-saving haemostasis; antimicrobials are adjunctive when infection is suspected.

Reference: Society of Obstetricians and Gynaecologists of Canada: Prevention and management of postpartum haemorrhage: https://sogc.org/common/Uploaded%20files/ACSC/ACSC2025/gui431CPG2212E.pdf