CODE"H"MANAGEMENT: CREATING AN AWARENESS
Abstract Number: 206
Abstract Type: Case Report/Case Series
INTRODUCTION: Obstetric hemorrhage remains the first cause of maternal mortality. Developing a multidisciplinary approach for the hemorrhage management is very essential for optimal outcomes. Peripartum hysterectomy is essential to save the life of the mother and the fetus, in many cases. We present a case series with different causes of maternal hemorrhage and the optimal management of the same.
CASE 1: 32 year old female at 38 weeks gestation,h/o multiple C-Sections is scheduled for repeat C-Section and possible hysterectomy. Combined- Spinal Epidural anesthesia was performed. Following the delivery, a diagnosis of Placenta accreta was made. Bilateral hypogastric arterial ligation and Cesarean Hysterectomy was performed
CASE 2: 27 year old, 38+ weeks gestation, was scheduled for C-Section for Twin gestation. Spinal anesthesia performed. After the delivery, Uterine atony, Not responding to uterotonic therapy. Emergency hysterectomy performed.
29 year old parturient,40 weeks of gestation was admitted for labor induction. Analgesia was provided by CSE. Following delivery of the placenta, uterine inversion and vaginal lacerations were diagnosed. Rapid sequence induction with succinylcholine, and ketamine. The Obstetric team was unable to reposition the uterus easily and proceeded with exploratory laparotomy. After the uterine inversion was reversed, the uterus was atonic. A subtotal hysterectomy was performed.
34 year old, H/o previous C-Section, underwent Repeat C-Section under spinal anesthesia. During the removal of cerclage, she lost 2600 ml of blood.
33 year old underwent C-Section for failed descent of the fetal head. Complicated by Cervical laceration.
In all the 5 cases, prompt resuscitation with crystalloids, colloids, blood products transfusion, vasopressor therapy was initiated with appropriate monitoring. Prior to hysterectomy, conservative methods were tried. All patients were managed in SICU postoperatively and had favorable outcomes.
*Our hospital is a tertiary care center with a very busy OB service- approximately 8000 deliveries per year. A Hemorrhage management protocol has been implemented,a conjoined effort by OB and Anesthesiology. Using a OB simulator, hemorrhage management drills have been initiated to train and educate the team members regarding team approach to the management of Obstetric hemorrhage.These initiatives have significantly improved the awareness and the efficiency.