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A 36-year-old woman with a significant history of postpartum hemorrhage is to undergo a laparoscopic tubal ligation at a freestanding ASC that requires minimal pre-procedure testing. The only test required of this patient is a pregnancy test, which was negative. The anesthesiologist and admitting nurse both elicit the history of postpartum hemorrhage, but are unconcerned given the circumstances. Following the vaginal delivery of her fourth child three years ago, the patient lost two liters of blood, caused by retained products of conception. She wasn't transfused at that time, although her hemoglobin on discharge had fallen to 6.8 grams.
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