Why do I have continous vaginal bleeding?

Patient's Query

Hello doctor,

I am writing on behalf of my wife. She is facing continuous bleeding from vagina since seven days after post pregnancy bleeding. Here is the complete scenario. We blessed with a baby 38 days ago and it was a C-section delivery. 16 days back the bleeding had stopped completely. Everything was normal. 10 days back my wife started to have vaginal bleeding again and bleeding till today. We thought that this is 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 have also visited doctor nearby yesterday. She has given two tablets to eat twice and day. Pause MF and Methergine were the tablets given. After having these tablets, bleeding is happening at same flow. BP and tiredness has disappeared. There is no other complication like fever, stomach pain, etc., except bleeding. She needs to feed one month baby as well. Also note that there is no sex done post-delivery. Please help us. I am attaching her CBC, PT, INR/PTT reports for your reference.

Answer

Dr. Sanjay Kumar Bhattacharyya

Obstetrics And Gynaecology

Hello,

Welcome to icliniq.com.

Your wife is having bleeding per vagina following one month of Cesarean section. This is termed postpartum hemorrhage and often creates an emergency.

This could be caused by an infection of C-section wound commonly. 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 subside the bleeding temporarily.

But, she needs intravenous antibiotics and may need clotting factor transfusion (fresh frozen plasma) as well as 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 the breastfeeding as a priority in contrast to your wife's impending danger, if any.

The Probable causes:

Blood coagulation disorder.

Investigations to be done:

1. Routine blood, liver function tests (LFT), urea, creatinine, platelet count, bleeding time (BT), clotting time (CT) prothrombin time (PT) and activated partial thromboplastin (APTT).
2. USG (ultrasonography) whole abdomen.

Probable diagnosis:

Postpartum hemorrhage.

Treatment plan:

Admission along with IV antibiotic as well as FFP transfusion and blood reserve required.

Regarding follow up:

Revert back after the investigations to an obstetrician and gynaecologist online.---> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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