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2. **Clinical Signs and Symptoms**:
- **Vital Signs**: Tachycardia (rapid heart rate), hypotension (low blood pressure), and tachypnea (rapid breathing) can indicate significant blood loss and shock.
- **Physical Examination**: Uterine atony (soft, boggy uterus), which fails to contract adequately after delivery, is a common cause of PPH. Other causes such as retained placental fragments, lacerations, or coagulopathies may also be identified through examination.
3. **Laboratory Tests**:
- **Hemoglobin and Hematocrit**: These tests can provide information on the extent of blood loss and help assess the severity of anemia.
- **Coagulation Profile**: In cases where a coagulopathy is suspected, tests like platelet count, PT (prothrombin time), aPTT (activated partial thromboplastin time), and fibrinogen levels may be performed.
4. **Identifying the Source**:
- **Uterine Examination**: To check for uterine atony or retained placental tissue.
- **Inspection of the Birth Canal**: To identify any lacerations or tears in the cervix, vagina, or perineum.
- **Ultrasound**: In some cases, an ultrasound may be used to detect retained products of conception or abnormal placental attachment.
### Criteria for Diagnosis
- **Primary PPH**: Blood loss of 500 ml or more within the first 24 hours after vaginal delivery, or 1000 ml or more following cesarean section.
- **Secondary PPH**: Abnormal or excessive bleeding from 24 hours to 12 weeks postpartum.
### Monitoring and Management
- **Close Monitoring**: Continuous monitoring of vital signs, uterine tone, and ongoing blood loss.
- **Rapid Intervention**: Initiating measures to control bleeding, such as uterine massage, medications (e.g., oxytocin, misoprostol), and surgical interventions if necessary (e.g., uterine artery embolization, hysterectomy).
Prompt recognition and management of postpartum hemorrhage are crucial to prevent severe maternal morbidity and mortality.