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Postpartum haemorrhage — the uterus that won't contract

Deliberate Practice

District hospital, night shift

Blood loss500 ml
HR105
SBP100
Shock index1.05
Elapsed0:00
Scenario
02:00, district hospital. A 26-year-old woman, para 3, delivered a healthy baby vaginally 15 minutes ago at term. The placenta came out complete. She is now bleeding heavily per vaginam and the midwife tells you the uterus feels soft. She looks pale. You are the clinician on duty — what do you do?