A maternal near-miss case of massive obstetric hemorrhage: Recent trends in management of hemostatic failure

Abstract

Obstetric hemorrhage is a leading cause of maternal mortality and morbidity. Uterine atony is the major cause of postpartum hemorrhage (PPH) accounting for 79% of all cases besides genital trauma, placental causes and coagulation disorders. We present a case of massive obstetric hemorrhage secondary to uterine atony that was referred to our center in a state of hemorrhagic shock with severe metabolic acidosis, hypothermia and coagulopathy. Prompt activation of massive transfusion protocol, use of thromboelastography guided correction of coagulopathy and early hysterectomy to control hemorrhage played a vital role in successful patient management. Postoperative intensive management of ventilatory function, haemodynamics, kidney function and sepsis led to a favourable outcome. This case highlights the importance of multi-disciplinary team management involving anesthesiologist, emergency medical personnel, obstetrician, blood transfusion services and critical care team in optimizing the clinical condition of the critical patient.

Keywords

• Massive transfusion protocol
• obstetric hemorrhage
• post-partum hemorrhage
• thromboelastography
• uterine atony