Post term pregnancy delivered with or without mention of antepartum condition Acute posthemorrhagic anemia Anemia of mother delivered with mention of postpartum complication Other immediate postpartum hemorrhage delivered with mention of postpartum complication Secondary uterine inertia delivered with or without mention of antepartum condition Outcome of delivery single liveborn
 
Name:  ___                   Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: OBSTETRICS/GYNECOLOGY
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___
 
Chief Complaint:
"s/p cesarean section complicated by PPH requiring transfusion"
 
Major Surgical or Invasive Procedure:
cesarean section

 
History of Present Illness:
The patient is a ___ gravida 2, para 0,
who presented in early labor on ___ after spontaneous
rupture of membranes.  She progressed to 8 cm at around 10
a.m. on ___ with expectant management, but cervical 
dilitation did not progress. The patient agreed to
augment her labor with Pitocin.  However, she did continue to
labor without neuraxial anesthesia.  The Pitocin was titrated
per protocol, but she did not make any cervical change for
several hours.  At this point an intrauterine pressure
catheter was recommended; the patient declined.  She did
elect for a combined spinal epidural and afterwards the
Pitocin was continued to be titrated per protocol.  However,
after 12 hours, she was still found to be 8 cm, 100%, and -1
station.  Therefore, the recommendation was made to proceed
with a primary cesarean section due to arrest.  The risks and
benefits were discussed with the patient and her partner, all
questions were answered, all consents were signed.  She had a
reassuring fetal status prior to surgery. Total EBL was 800cc.

She was transferred to the postpartum floor and then experienced 
several gushed of bright red blood mixed with clots from her 
vagina.  She was brought back to the Labor floor.
 
Social History:
___
Family History:
Non-contributory
 
Physical Exam:
On examination during PPH, pt had bled out 400cc of blood clots 
in the bed. U/S showed some lower uterine segment clots. 
Endometrial stripe appeared adequate. Evacuated 400cc more of 
blood from lower uterine segment. She received 1000mcg of 
cytotec and 40 units of pitocin. Pt was transferred back to 
labor and delivery for continued bleeding.
 
Pertinent Results:
___ 12:15AM BLOOD WBC-15.5* RBC-4.59 Hgb-14.1 Hct-39.4 
MCV-86 MCH-30.7 MCHC-35.7* RDW-13.4 Plt ___
___ 12:41AM BLOOD WBC-20.4* RBC-3.91* Hgb-12.3 Hct-33.8* 
MCV-87 MCH-31.4 MCHC-36.4* RDW-13.6 Plt ___
___ 03:27AM BLOOD WBC-22.4* RBC-3.50* Hgb-10.9* Hct-30.3* 
MCV-87 MCH-31.2 MCHC-36.0* RDW-13.7 Plt ___
___ 07:31AM BLOOD WBC-15.9* RBC-2.71* Hgb-8.2* Hct-23.2* 
MCV-86 MCH-30.1 MCHC-35.2* RDW-13.8 Plt ___
___ 05:06PM BLOOD WBC-15.1* RBC-3.05* Hgb-9.7* Hct-26.9* 
MCV-88 MCH-31.7 MCHC-36.0* RDW-14.1 Plt ___
___ 08:35AM BLOOD WBC-16.6* RBC-2.90* Hgb-9.0* Hct-25.6* 
MCV-88 MCH-30.9 MCHC-35.0 RDW-14.2 Plt ___
 
Brief Hospital Course:
Ms. ___ was transferred back to labor and delivery when her 
bleeding failed to stop with 40 units of pitocin, 1000mcg of 
cytotec and manual evacuation. Her bleeding however did resolve  
after she received 0.2mg of IM Methergine. Her HCT was trended 
and found to nadir at 23.2.  She had tachycardia and a low urine 
output. The decision was the made to transfuse her for 
symptomatic anemia. She received 2 units of red cells and her 
hematocrit responded appropriately to 25.6, her urine output and 
heart rate improved significantly.

The rest of her postpartum course was uncomplicated.
 
Medications on Admission:
- Prenatal vitamins
 
Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
times a day) as needed for Constipation.
Disp:*60 Capsule(s)* Refills:*1*
2. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO 
Q3H (every 3 hours) as needed for Pain.
Disp:*45 Tablet(s)* Refills:*0*
3. ibuprofen 600 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
hours) as needed for Pain.
Disp:*60 Tablet(s)* Refills:*1*
4. ferrous sulfate 325 mg (65 mg iron) Capsule, Extended Release 
Sig: One (1) Capsule, Extended Release PO twice a day.
Disp:*60 Capsule, Extended Release(s)* Refills:*2*

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
s/p cesarean section
s/p blood transfusion

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

 
Discharge Instructions:
routine postpartum
 
Followup Instructions:
___

{'bleeding': ['Acute posthemorrhagic anemia', 'Other immediate postpartum hemorrhage'], 'cesarean section': ['Post term pregnancy', 'Secondary uterine inertia'], 'labor': ['Post term pregnancy', 'Secondary uterine inertia'], 'rupture of membranes': ['Post term pregnancy', 'Secondary uterine inertia'], 'PPH': ['Acute posthemorrhagic anemia', 'Other immediate postpartum hemorrhage']}