Secondary PPH with a vascular lesion — emergency management station

Emergency-management station: secondary PPH driven by a uterine artery pseudoaneurysm. Tests resuscitation, recognition of the vascular lesion, the refusal to curette, interventional-radiology activation, and communication. Includes assessor timeline, marking domains and assessor key.

Prompt

A 31-year-old woman presents to the emergency department 14 days after a caesarean birth with sudden torrential vaginal bleeding. She has passed large clots. HR 118, BP 96/58, afebrile. A bedside ultrasound shows a near-empty cavity, but Doppler demonstrates a cystic myometrial lesion with turbulent high-velocity flow. You are the registrar with the consultant 10 minutes away.

Station brief

Format. Emergency-management station, approximately 12 minutes. You are the registrar in the emergency department. The assessor runs the clock and feeds new observations. The trap in this station is the reflex to evacuate a bleeding cavity — a curette here will open a pseudoaneurysm and convert a treatable lesion into a laparotomy. ^[3]

Candidate instruction. Lead the resuscitation and definitive management. Verbalise your recognition of the vascular lesion, your decision not to curette, your activation of interventional radiology, and your communication with the team and the woman. ^[3]

References4Show

[1]Hoveyda F, MacKenzie IZ Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG, 2001.PMID 11563461
[2]Yagur Y, Jurman L, Weitzner O, et al. Ultrasound for diagnosis of postpartum retained products of conception-How accurate we are? BMC Pregnancy Childbirth, 2023.PMID 37563560
[3]Alonso-Burgos A, Díaz-Lorenzo I, Muñoz-Saá L, et al. Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach. CVIR Endovasc, 2024.PMID 38349501
[4]Mackeen AD, Packard RE, Ota E, et al. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev, 2015.PMID 25922861

Secondary PPH with a vascular lesion — emergency management station

Station brief

References4Show

[1]Hoveyda F, MacKenzie IZ Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG, 2001.PMID 11563461
[2]Yagur Y, Jurman L, Weitzner O, et al. Ultrasound for diagnosis of postpartum retained products of conception-How accurate we are? BMC Pregnancy Childbirth, 2023.PMID 37563560
[3]Alonso-Burgos A, Díaz-Lorenzo I, Muñoz-Saá L, et al. Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach. CVIR Endovasc, 2024.PMID 38349501
[4]Mackeen AD, Packard RE, Ota E, et al. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev, 2015.PMID 25922861