History of present illness A 45-year-old gravida 6, para 6 woman presents to the emergency department with a complaint of 2 days of heavy vaginal bleeding and passing clots. She is light-headed and short of breath. Previously she had regular but heavy periods. A few days prior to this bleeding episode she noted increasing pelvic pressure and a malodorous vaginal discharge. Her past medical history is significant for recurrent anemia thought to be from abnormal uterine bleeding. Her surgical history is significant for a previous postpartum tubal ligation. She takes no medications.