Near-mortality Scenarios in Obstetrics: Case Studies of Severe Complications and their Management

Abstract

Near-mortality instances among women facing severe obstetric complications, often referred to as “maternal near-miss” cases, involve situations where women experience life-threatening complications during pregnancy, childbirth, or postpartum but survive due to timely and effective medical interventions. These cases are critical for understanding healthcare gaps, risk factors, and improving maternal health outcomes. The present case series examines five near-miss instances among women experiencing severe obstetric complications. Case 1 details a 28-week primigravida with Dichorionic-Diamniotic twins (DCDA) and severe preeclampsia, leading to an emergency caesarean section. She presented with Haemolysis, Elevated Liver enzymes, Low Platelets syndrome (HELLP), and Disseminated Intravascular Coagulation (DIC). Case 2 involves a 37-year-old Gravida 3 Para 2 Living 0 Abortion1 (G3P2L0A1) woman with 28.5-week In-vitro Fertilisation (IVF)-conceived DCDA twins and a history of a previous Lower Segment Caesarean Section (LSCS), requiring an emergency subtotal obstetric hysterectomy due to Postpartum Haemorrhage (PPH). Case 3 describes a 35-year-old primigravida at 39.4 weeks with a retained placenta, managed through step-wise interventions, which eventually resulted in the spontaneous expulsion of the placenta. Case 4 presents a 32-year-old multigravida at 40.3 weeks with uterine rupture and abruptio placentae, necessitating an obstetric hysterectomy. Lastly, Case 5 involves a 27-year-old female with a scar ectopic pregnancy, treated successfully with methotrexate. These cases underscore the critical need for timely medical interventions and improved maternal healthcare systems to manage life-threatening obstetric emergencies effectively.

Keywords

• hysterectomy
• preeclampsia
• retained placenta
• ruptured uterus
• scar ectopic