instruction: 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 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 to 10 pads a day she is feeling tired and her be was low due to excessive bleeding we have also visited doctor nearby yesterday she has given two tablets to eat twice and day pause of and methergine were the tablets given after having these tablets bleeding is happening at same flow be 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 abc it in ptt reports for your reference
output: hello 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 section wound commonly but as per your report she is having some form of blood clotting disorders raised prothrombin time it and international normalized ratio in 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 of 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 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 impending danger if any blood coagulation disorder routine blood liver function tests let urea creatinine platelet count bleeding time bt clotting time it prothrombin time it and activated partial thromboplastin apt us ultrasonography whole abdomen postpartum hemorrhage admission along with iv antibiotic as well as fop transfusion and blood reserve required revert back after the investigations to an obstetrician and gynaecologist online