Peripartum life-threatening haemorrhage - 2018

You are called as an anaesthetist to the delivery room to the 30 years old woman in labour (V-gravida, III-para). The delivery was physiological in term, performed in epidural analgesia, common blood loss during the birth (I. stage of labour 8 hours, II. stage of labour 10 minutes), the boy was delivered (3950 g, 52 cm, Apgar score 8-10-10). At the beginning of third stage of labour strong bleeding from genitals appears, there is a blood loss of 500 mL within 5 minutes. Shortly after the delivery of the placenta, the patient is conscious, pale, tachycardic, free of signs of respiratory insufficiency. What will be your next step?
30
years
woman
RR
23 /min
HR
118 /min
SpO2
92 %
BP
87/59 (68) mmHg
Glycaemia
Gly
4,5  mmol/L
Complete blood count
HGB
145  g/L
HTC
0,45
ERC
4,9  x1012/L
LEU
6,6  x109/L
Biochemical analysis
Na
138  mmol/L
K
4,4  mmol/L
Cl
103  mmol/L
Mg
0,8  mmol/L
Ca
2,56  mmol/L
P
0,9  mmol/L
Glycaemia
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Complete blood count
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Biochemical analysis
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