Overview
The Clinical Problem
Postpartum hemorrhage can look deceptively manageable at first.
REx-PN
REx-PN
Postpartum hemorrhage can look deceptively manageable at first. A patient may be awake, speaking, and normotensive while tachycardia and pallor signal that circulating volume is already falling. The uterus normally contracts after placental separation, compressing the open vessels at the placental site; when it stays relaxed, bleeding can continue rapidly and invisibly into pads, linens, or the uterine cavity. At the bedside, two questions must be answered together: how much blood has been lost, and why is it still bleeding? A soft uterus points toward atony, whereas brisk bleeding from a firm uterus shifts attention to trauma, retained tissue, or coagulopathy. The response is time-sensitive: quantify the loss, support perfusion, call the obstetric and anesthesia teams, and treat the likely source without waiting for hypotension.
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