| Abstract [eng] |
SUMMARY Discussion. Postpartum hemorrhage is defined as ≥ 500 ml blood loss during natural delivery or ≥ 1000 ml during caesarean section. The incidence of postpartum bleeding has been increasing in recent years. Massive obstetric bleeding is one of the most common causes of maternal death. The most common causes of bleeding are uterine atony, trauma, placental abruption in the uterus and coagulation disorders. Due to physiological changes during pregnancy, the classic symptoms of hypovolemia may occur later with the loss of large amounts of blood. As a result, the diagnosis of postpartum hemorrhage is sometimes delayed. Oxytocin is the drug of choice for postpartum hemorrhage. Anesthesiologists must be able to manage the rapidly changing condition of a bleeding woman, choose the right methods of anesthesia and treatment, ensure not only the vital functions of the mother, but also the fetus. Case description. 25-years-old woman was transferred to the Vilnius University Hospital Santaros Clinics obstetrics department due to suspected preeclampsia and elevated blood pressure. She had no complaints at the time of admission. 1 g of protein was found in the urine. Childbirth was induced by synthetic prostaglandins. Deep fetal bradycardia occurred with the onset of regular labor. Due to the acute nature of the situation, it was decided to perform an emergency caesarean section under general anesthesia. The operation was successful, with sluggish uterine contractions. Bleeding from the genital tract (800 ml) was observed in the postoperative ward after 20 minutes. As the bleeding continued, even with medication, it was decided to stop the bleeding surgically during the revision operation. During the operation, massive transfusions of blood components were performed, bleeding ~ 4000 ml. After surgery, the patient was transferred to intensive care unit for further treatment. The treatment at the intensive care continued for two days, conservative treatment and transfusions of blood products were used. After two days the patient was transferred to the obstetric ward and discharged from the hospital four days later. |
