A patient underwent LSCS for arrest of second stage of labour. A lateral extension of an angle of uterine incision occurred during delivery of head which was secured. Post operatively after 2 hours patient develops pallor, abdominal distension with tachycardia. Hb dropped from 10 gm% (pre op) to 6.5 gm%. Pelvic exam revealed mild PPH. Next step in management is?
Patient here is showing signs of hemodynamic compromise post LSCS which had a lateral extension and a drop in hemoglobin suggestive of acute hemorrhage. Mild PPH does not correspond with the amount of compromise and anemia. Therefore it appears to be a case of intraabdominal bleeding from lateral extension or an unidentified bleeder, which should be immediately explored and secured.
Uterotonics for control of PPH and blood transfusion
Blood transfusion and monitoring
Immediate exploration in OT
Intrauterine packing and blood transfusion
Obstetrics