You are called to a maternity ward to see a 23 year-old primi patient who had delivered a 2.7 kg baby boy 2 days back. She had a normal vaginal delivery and placenta delivered spontaneously. Now she complains of bloody vaginal discharge with no other signs. O/E you notice a sweetish odour bloody discharge on the vaginal walls and introitus. Sterile pelvic examination shows a soft nontender uterus. Her P/R-78/min, B/P-110/76 mm of hg, temp-37degC, R/R-16/min. Her WBC count = 10,000 with predominant granulocytes. What is the most appropriate step?

**Core Concept**
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. The patient's presentation of a sweetish odor bloody discharge, known as Lochia rubra, is a common finding in the early postpartum period. However, the presence of a significant amount of blood and a soft, non-tender uterus suggests that the patient may be experiencing a secondary postpartum hemorrhage, which is a potentially life-threatening condition.

**Why the Correct Answer is Right**
The patient's symptoms and examination findings are suggestive of a secondary postpartum hemorrhage. The sweetish odor bloody discharge is likely due to the presence of blood and other tissue products in the vagina. The soft, non-tender uterus and the presence of granulocytes in the WBC count suggest that the bleeding is likely due to an infection. The most appropriate step in this scenario would be to administer antibiotics to cover for common postpartum infections, such as endometritis. This would help to prevent the progression of the infection and reduce the risk of complications.

**Why Each Wrong Option is Incorrect**
* **Option A:** Administering a uterotonic agent, such as oxytocin, may not be effective in this scenario as the uterus is soft and non-tender, suggesting that the bleeding is not due to uterine atony.
* **Option B:** Performing an ultrasound may not be necessary in this scenario as the patient's symptoms and examination findings are suggestive of a secondary postpartum hemorrhage. An ultrasound may not provide any additional information that would change the management plan.
* **Option C:** Performing a cesarean section may not be necessary in this scenario as the patient's symptoms and examination findings are suggestive of a secondary postpartum hemorrhage, not a complication of the delivery.

**Clinical Pearl / High-Yield Fact**
It is essential to remember that secondary postpartum hemorrhage is a medical emergency that requires prompt recognition and treatment. The presence of a sweetish odor bloody discharge, a soft, non-tender uterus, and granulocytes in the WBC count are all red flags for secondary postpartum hemorrhage.

**Correct Answer:** C. Administer antibiotics to cover for common postpartum infections.

✓ Correct Answer: C. Reassurance