You are called to a maternity ward to see a 23 year-old primi patient who had delivered a 2.7 kg baby boy 2 days back. She had a normal vaginal delivery and placenta delivered spontaneously. Now she complains of bloody vaginal discharge with no other signs. O/E you notice a sweetish odour bloody discharge on the vaginal walls and introitus. Sterile pelvic examination shows a soft nontender uterus. Her P/R-78/min, B/P-110/76 mm of hg, temp-37degC, R/R-16/min. Her WBC count = 10,000 with predominant granulocytes. What is the most appropriate step?
Ans. is c, i.e. ReassuranceRef. Dutta Obs 7/e, p 146This patient is a puerperal female who is complaining of bloody vaginal discharge with no other significant abnormal signs. On examination there is a sweetish odour bloody discharge on the vaginal walls and introitus. Her vitals are normal suggesting that this cannot be PPH (The most common cause of secondary PPH is retained bits of placenta for which curettage is done, but here it is not required).Slight amount of bloody discharge called as lochia is absolutely normal for the first 15 days after delivery and does not require any treatment, so we will reassure the patient and do nothing.Do not get confused with the finding of WBC count, 10,000 with predominant granulocytes as this is a normal finding in the puerperal period. Note- leucocytes can rise to as high as 25000 during puerperium probably as a response to the stress of labor). Since lochia has no foul smell it means no infection and so no need for culture or antibiotics.
Currettage
Oral antibiotics
Reassurance
Order urinalysis
Abnormality of Puerperium