What causes continuous vaginal bleeding?

Question

Hello doctor,

I am writing on behalf of my wife. She has been facing continuous bleeding from the vagina for seven days after post-pregnancy bleeding. Here is the complete scenario. We were blessed with a baby 38 days ago, and it was a C-section delivery. Sixteen days back, the bleeding had stopped completely. Everything was normal. Ten days ago, my wife started to have vaginal bleeding again, and bleeding till today. We thought that this was her monthly period after pregnancy. The bleeding is heavy, so she needs to change 8 to 10 pads a day. She is feeling tired, and her BP was low due to excessive bleeding. We also visited the doctor nearby yesterday. She has been given two tablets to take twice a day. Pause MF and Methergine were the tablets given. After having these tablets, bleeding is happening at the same rate. BP and tiredness have disappeared. There is no other complication like fever, stomach pain, etc., except bleeding. She needs to feed a one-month-old baby as well. Also note that there is no sex done post-delivery. I am attaching her CBC, PT, and INR/PTT reports for your reference.

Please help us.

Answer 1

Hello,

Welcome to icliniq.com.

Your wife is having bleeding per vagina following a Cesarean section. This is termed postpartum hemorrhage and often creates an emergency. This could be caused by an infection of the C-section wound. But, as per your report (attachment removed to protect patient identity), she is having some form of blood-clotting disorders, raised prothrombin time (PT) and international normalized ratio (INR).

Now, definitely, she needs hospitalization. She might have another bout of bleeding, and in that case, you will not be able to control the situation. Pause MF (combination of Tranexamic acid and Mefenamic acid) and Methergine (Methylergometrine) can temporarily subdue the bleeding.

But, she needs intravenous antibiotics and may need a clotting factor transfusion (fresh frozen plasma) as well as a blood transfusion. As her hemoglobin is 10.8, it is substantially low to combat another episode of massive bleeding. I know the baby will be deprived, but do not take breastfeeding as a priority in contrast to your wife's impending danger, if any.

I also recommend performing the following investigations to guide further management:

Routine blood tests.
Liver function tests (LFT).
Urea and creatinine.
Platelet count.
Bleeding time (BT), clotting time (CT), prothrombin time (PT), and activated partial thromboplastin time (APTT).
Ultrasonography (USG) of the whole abdomen.

Revert with the answer to assist further.

Thank you, and take care.

Regards.