Early Haemorrhage Postpartum (HPP); With Complication Disseminated Intravascular Coagulation, Sepsis, Acute Kidney Injury

Authors

  • Rizki Oktavian Department of Obstetry and Gynecology, Faculty of Medicine, Andalas University/Dr. M. Djamil, Padang
  • Gunawan Efri Department of Obstetry and Gynecology, Faculty of Medicine, Andalas University/Dr. M. Djamil,Padang
  • Roza Sriyanti Fetomaternal Subdivision, Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University/Dr. M. Djamil Hospital, Padang
  • Emilzon Taslim Department of Anesthesia and Intensive Therapy, Faculty of Medicine, Andalas University, RSUP Dr.M. Djamil Padang, Indonesia

DOI:

https://doi.org/10.25077/aoj.8.1.632-641.2024

Keywords:

preeclampsia, early onset, late onset, normal pregnancy, urinary Cystatin-C

Abstract

Background : Hemorrhage Postpartum (HPP) is the leading cause of maternal death worldwide with an incidence of 5%-10% of all deliveries. 70% of cases of HPP are caused by atony of the uterus. If HPP is not handled properly, it will cause worsening of the patient's condition which causes various multiorgan complications.


Objectives : To discuss the management of HPP cases complicated by DIC, sepsis and AKI.


Method : case report.

Case : A female patient, 36 years old, was referred from a private hospital to PONEK RSUP Dr. M. Djamil Padang with a diagnosis of decreased consciousness ec suspected sepsis in post SCTPP oi used SC 2x + post relaparotomy oi bleeding subfascia + moderate anemia. After surgery, the patient looked pale and the hemoglobin was 7, then relaparotomy was done and done B-lynch oi uterine hypotony. After relaparotomy, the patient experienced worsening then referred to the hospital. The patient arrives with hipovolemic shock + AKI + Sepsis + DIC , then the condition improvement is carried out in ROI and hysterectomy relaparotomy is performed. The patient has worsened, maximum treatment has been carried out from the intersivist, but the patient's condition continues to worsen and eventually dies.
Conclusion : Early diagnosis and rapid treatment through a multidisciplinary team and the availability of an Intensive Care Unit (ICU) can prevent complications and reduce morbidity and mortality.

References

Cunningham et al. Williams Obstetric. 25th Edition. http://t.me/ebookers; 2018

Kementerian Kesehatan RI. Profil Kesehatan Indonesia 2020. Jakarta; 2020.

Queensland Health. Primary Postpartum Haemorrhage. Queensland Clinical Guideline 2018 march MN18.1-V7-R23

The Society of Obstetricians and Gynaecologists of Canada. Alarm Course Manual 22nd Edition. SOGC. 2016; 16 :1-37.

Rani, P.Reddi, Begum Jasmina.Recent Advances in the Management of Major Post Partum Hemorrhage-a review. Journal of Clinical & Diagnostic Research 2017 Feb vol 11 (2) QE01-QE05

WHO. WHO Guideline for the Management Postpartum Hemorrhage and Retain Placenta. World Health Organization; 2009

Begum Jasmina, et.all. B-Lynch; a Technique for Uterine Conservation or Deformation? A Case Repport with Literature Review. International Journal of Gynecology and Obstetric 2014 apr, vol-8(4): OD01-0D03

FIGO. Prevention and Treatment of Post Partum Hemorrhage in Low-resource setting. International Journal of Gynecology and Obstetric 117 (2012) 108-118

POGI. Pedoman Nasional Pelayanan KesehatanPerdarahan Pasca-Salin. Perkumpulan Obstetri dan Ginekologi Indonesia Himpunan kedokteran Fetomaternal 2016

Karkata MK, Kristanto H. Panduan Penatalaksanaan Kasus Obstetri. Himpunan Kedokteran Fetomaternal POGI. 2012; 11 : 160-183

Hoelman, Mickael B., et.all. PANDUAN SDGs untuk Pemerintah Daerah (Kota dan Kabupaten) dan Pemangku Kepentingan Daerah. International NGO Forum on Indonesian Development; 2015

Shakur, et.all. The Woman Trial (World Maternal Antifibrinolytic Trial); Tranexamic acid for the Treatment of Postpartum Haemorrhage; an International Randomised, Double Blind placebo Controlled Trial. UK: Biomed Central: 2010

ACOG. Clinical Management for Obstetrician-Gynecologist: Postpartum Haemorrhage. ACOG Practice Buletin vol 130, no. 4, October 2017

NHS. Obstetric Haemorrhage – Clinical Guideline. Royal Cornwall Hospitals. NHS Trust. V2.1 2018

Al Banna, Weaam Nabil. Postpartum Haemorrhage and How to be Managed. EC Gynaecology 5.6 (2017) 223-229

The RANZCOG. Management of Postpartum Haemorrhage (PPH). The Royal Australian and New Zealand College of Obstetrician and Gynecologist: 2017

Balogoun-Lynch Christopher and Whitelaw Naomi. The Surgical Management of Postpartum Haemorrhage. Cambridge University. Fetal and Maternal Medicine Review 2006; 17:2 105-123

E. Mavrides, etal. Prevention and Management of Postpartum Haemorrhage. BJOG 2016;124:e126-e149

Edhi, et al. Postpartum Haemorrhage: Cause and Management. BMC Research Notes 2013, 6:236.

Singer, M. et al. The third international consensus definitions for sepsis and septic shock(sepsis-3). JAMA - J. Am. Med. Assoc. 315, 801–810 (2016).

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C et al. Acute kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical care2017,11:R31

Thachil, J. & Toh, C. H. Disseminated intravascular coagulation in obstetric disorders and its acute haematological management. Blood Rev. 23, 167–176 (2019).

Al Wattar et al. Management of Obstetric Postpartum Hemorrhage: a National Service Evaluation of Current Practice in the UK. Risk Management and Healthcare Policy. 11 January 2017.

Yamashita Y, et.all. Intra-aortic Balloon Occlusion without Flouroscopy for Life-threatening Post-partum Haemorrhage. De Gruyter. Med. 2016;5(1): 19- 22

Himmelfarb J, Joannidis M, Molitoris B, Schietz M, Okusa MD, Warnock D et al. Evaluation and Initial Management of Acute Kidney Injury. Clin J Am Soc Nephrol 3:962-967,2018

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Published

2024-01-30

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CASE REPORT