1.         A 29-year-old Malay lady Gravida 5 Para 4 has had an uncomplicated normal delivery of a 3.5kg infant 1 hour ago. You are called to see her as her BP is 90 / 60mmHg, pulse rate is 100 / min. She is pale and bleeding PV.

a)         What is the likely diagnosis?

             Postpartum haemorrhage.

b)         What is the likely cause of her condition?

            Uterine atony.

c)         What is the first thing you would do at the bedside?

            Palpate uterus to see if it’s contracted.

d)         What are the 2 medical agents you would use in the management of this patient?

            Syntocinon and ergometrine.

e)         If she continues to bleed, what are the other 2 conditions you must exclude?

            Retained products of conception, genital trauma, uterine inversion.

f)          If the bleeding continues despite all medical measures, name 2 surgical interventions you would consider.

            Uterine artery ligation. Hysterectomy.