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Perioperative Management of Bleeding Due to Uterine Atony/Rupture in a Parturient after Vaginal Delivery and Intensive Care Unit Follow-up: Pharmacological, Surgical and Interventional Therapies
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Case Report
VOLUME: 18 ISSUE: 1
P: 47-53
March 2020

Perioperative Management of Bleeding Due to Uterine Atony/Rupture in a Parturient after Vaginal Delivery and Intensive Care Unit Follow-up: Pharmacological, Surgical and Interventional Therapies

J Turk Soc Intens Care 2020;18(1):47-53
DOI: 10.4274/tybd.galenos.2019.82473
Berrin Günaydın 1
Gözde İnan 1
Ezgi Turgut 2
Deniz Karçaaltıncaba 2
Ali Cin 1
Nazuha Mohd Najit 1
Selin Erel 1
Lale Karabıyık 1
1. Gazi Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, Türkiye
2. Gazi Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye
3. Gazi Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, Türkiye
4. Gazi Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, Türkiye
5. Gazi Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye
6. Gazi Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye
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Received Date: 22.03.2019
Accepted Date: 15.04.2019
Publish Date: 20.02.2020
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ABSTRACT

We aimed to present perioperative management of bleeding due to uterine atony and/or rupture and postoperative intensive care unit (ICU) follow-up of a parturient after spontaneous vaginal delivery. A 36-year-old parturient at 41 weeks of gestation with a history of epilepsy was admitted for induction of labor. During pushing, she had a grand mal seizure treated with diazepam. After delivery of the placenta, emergency hysterectomy under general anesthesia was required to control bleeding despite treatment with uterotonics (carbetocine, methylergonovine, and misoprostol) and tranexamic acid followed by Bakri balloon placement. Crystalloids (2 L), colloids (1.5 L), blood products (3 erythrocyte suspension, 4 fresh frozen plasma) and 2 grams (g) of IV fibrinogen concentrate were administered throughout the operation. After extubation, the patient was transferred to ICU and 1 g of IV fibrinogen was administered. During her ICU follow-up, hemoglobin decreased to 7.3 g/dL and a bleeding from uterine artery was diagnosed, and embolization was performed by interventional radiology. Patient was transferred to ward and discharged on the postoperative 7th day. Consequently, perioperative management of postpartum haemorrhage with use of fibrinogen along with uterotonics, blood/blood products and fibrinogen demonstrated to be life saving in an epileptic parturient who underwent emergency hysterectomy because of atony and/or rupture after spontaneous vaginal delivery.

Keywords: Obstetric hemorrhage, fibrinogen, intensive care unit follow up

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