CASE: Unremitting bleeding after vaginal delivery A nurse-midwife delivered a macrosomic fetus and identified multiple cervical, vaginal, and perineal tears. After spending approximately 30 minutes suturing a few of the vaginal lacerations, she realized that she needed an experienced obstetrician to complete the complex repair. She has consulted you. You introduce yourself to the patient, obtain consent, and begin to assess the situation. You note that she has a tear of the anterior cervix at its intersection with the vagina; a few deep vaginal lacerations; and a fourth-degree tear. The uterus is well-contracted and the abdomen is not distended.As you sit to begin the repair, you notice diffuse oozing of blood from all areas of vaginal and perineal trauma. You suture the cervical laceration and notice that, after tying the stitch, bleeding is continuing from the closed laceration.Based on what you’re seeing, you become suspicious that the patient has a coagulopathy. What should you do?
