Approach to postpartum hemorrhage Quiz: Ace Your Exams

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A 32-year-old woman is brought to the emergency department for passing clots and experiencing fevers and chills for two days. The patient delivered a healthy baby girl one week ago via cesarean section at 38 weeks gestation. The patient has no significant past medical history. Temperature is 38°C (100.4°F), blood pressure is 100/67 mmHg, pulse is 98/min, respiratory rate is 16/min, and oxygen saturation is 99% on room air. Physical examination reveals a well-healing Pfannenstiel incision without overlying tenderness or drainage. Bimanual exam reveals moderate uterine tenderness and malodorous vaginal discharge. Urinalysis is negative. Laboratory studies are shown below. The patient is admitted to the obstetric unit and given ceftriaxone, doxycycline, and metronidazole. On day three of hospitalization, the patient reports worsening pelvic pain with continued passage of large clots, and she had persistent fevers. Which of the following is the best next step in management?  

Laboratory value
Result
Hemoglobin
9.8  g/dL
Hematocrit
35 %
Leukocyte count
21,100 /mm3
Platelet count
256,000/mm3
aPTT
35 s
PT/INR
1.5

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