Approach to postpartum hemorrhage Quiz: Ace Your Exams

A 32-year-old G4P4 woman is evaluated for vaginal bleeding immediately following spontaneous vaginal delivery of a baby boy at 38 weeks gestation. The placenta is delivered without problems and appears intact on gross examination. The patient is otherwise healthy and does not take any medication daily. Her pregnancy was uncomplicated. She has three other living children who were delivered without complications. Temperature is 37°C (98.6°F), blood pressure is 102/60 mmHg, pulse is 105/min, respiratory rate is 22/min, and oxygen saturation is 97% on room air. On physical examination, the patient appears pale and anxious. There are no vaginal or cervical lacerations or hematomas. There is evidence of continued, profuse vaginal bleeding from the cervical os without evidence of masses in the endometrium. On a bimanual exam, the uterus feels boggy and soft. Which of the following is the most appropriate next step in management?