OBSadvanced
What key clinical findings differentiate a patient suitable for conservative management from one requiring immediate escalation (e.g., examination under anaesthesia, surgical intervention, or embolisation) in secondary postpartum haemorrhage (PPH)?
Answer
Conservative management is appropriate for haemodynamically stable patients with mild or settling vaginal bleeding, a non-tender, appropriately involuted uterus, and no signs of systemic infection or sepsis. Immediate escalation is indicated if there is haemodynamic instability, heavy or torrential ongoing bleeding, signs of sepsis or endometritis, or ultrasound evidence of significant retained products of conception requiring surgical evacuation.
Explanation
The slides base management on bleeding severity, uterine findings, and infection. Stable cases may be observed and investigated, but heavy bleeding or sepsis requires active treatment and source control. Persistent torrential bleeding and vascular abnormalities require escalation. **Key takeaway:** Secondary PPH management is cause-directed and severity-dependent.\n\n**Glossary:** **Source control**: intervention that removes or controls the underlying cause of infection or bleeding.
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