The presence of what after postpartum hemorrhage indicates the need for surgical intervention?

The need for surgical intervention following postpartum hemorrhage is primarily indicated by ongoing significant bleeding despite treatment. When a patient experiences postpartum hemorrhage, the initial management typically involves pharmacological measures, such as uterotonics and supportive care. However, if these interventions fail and there is persistent, significant bleeding, it raises the concern for more serious underlying issues, such as retained placental fragments or uterine rupture, which may require surgical intervention to control the bleeding and address the underlying cause.

Recognizing that significant bleeding is ongoing despite adequate treatment informs the healthcare provider that standard management is not sufficient and that further action, such as dilation and curettage (D&C) or other surgical measures, may be necessary to prevent severe complications, including hypovolemic shock or even death.

Other factors, like increased risk for infection or uterine atony, are certainly considered in the overall management of postpartum hemorrhage, but they do not directly necessitate surgical intervention unless they lead to ongoing bleeding. Incisional pain may indicate surgical complications but, in itself, would not typically dictate immediate surgical intervention unless it is part of a broader pattern of concerning symptoms that include bleeding.