One hour after giving birth to baby Varkey, Mrs. Shah states that she feels lightheaded as she sits upright for the first time. Her midwife who has been monitoring her closely following the delivery helps her to lay back down. She notes that Samira is somewhat pale and that her pulse is rapid and thready. She palpates the uterus and finds the fundus is above the umbilicus. As the midwife massages the fundus, a large grapefruit size blood clot is expressed followed by blood that soaks the bed sheets. As summoned help arrives, Samira’s BP is found to be 85/50 and her heart rate 120.