Postpartum Bleeding

First actions / assessment

• Assess ABCDE first and estimate severity before focusing on cause. Clarify postpartum day, mode of delivery, estimated blood loss at delivery, placenta delivery details, retained placenta history, postpartum haemorrhage history, operative delivery, perineal trauma or episiotomy, caesarean section, anticoagulant use, current amount of bleeding, clots, dizziness, abdominal pain, uterine cramping, offensive discharge, fever, breast symptoms, urinary symptoms, wound pain, and whether bleeding is worsening or persistent rather than settling. Examine vitals, perfusion, abdominal tenderness, uterine size and tenderness, perineum if appropriate, caesarean or perineal wounds, and assess for sepsis. Initial investigations commonly include CBC, group and save/crossmatch if significant bleeding is suspected, coagulation profile if major bleeding, U&E, CRP if infection suspected, lactate if shocked or septic, and pelvic ultrasound when retained products are suspected, recognizing that imaging supports but does not replace clinical assessment.