A low risk primigravida underwent vaginal delivery with episiotomy. 2 hours after delivery patient appears pale, PR 110/min BP is 90/60 but there is no apparent PPH. PV examination shows a bulge over episiotomy stitch line. Hb shows a drop in Hb from 9 gm% to 7 gm%. Management is?: (A) Blood and fluid transfusion with IV antibiotics, (B) Blood transfusion and cold compression of episiotomy, (C) Immediate exploration of episiotomy and blood transfusion, (D) Cervical exploration with uterotonics with blood transfusion
Answer is C. The patient is showing signs of hemodynamic compromise with a significant drop in hemoglobin. This is suggestive of acute haemorrhage. As uterine bleeding is not evident and a bulge is present at site of episiotomy, it appears to be a case of a large hematoma at episiotomy which should be urgently explored, evacuated and bleeder should besecured.