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Severe Postpartum Coagulopathy Without Haemorrhage: A Case Report.
Muriel Lérias-Cambeiro1, Anabela Rodrigues2, Inês Taborda1
1Department of Anaesthesiology, Hospital de Santa Maria. Centro Hospitalar Lisboa Norte, Portugal.
Acta Medica Portuguesa
|October 18, 2018
Summary
Severe coagulopathy, a rare cause of postpartum hemorrhage, can occur even without bleeding after cesarean delivery. Thromboelastometry-guided transfusion management is key for positive outcomes in obstetric emergencies.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide.
- Common causes include uterine atony, retained placental tissue, trauma, and coagulation disorders.
- Coagulopathy, though rare, is a significant contributor to severe PPH with poor outcomes.
Observation:
- A unique case of severe coagulopathy following a cesarean section is presented.
- Underestimated blood loss during surgery, without overt postpartum bleeding, led to coagulopathy.
- Transfusion management was guided by rotational thromboelastometry (ROTEM).
Findings:
- Thromboelastometry-guided transfusion effectively managed severe coagulopathy in this obstetric emergency.
- Early multidisciplinary collaboration and patient-centered care were crucial.
- This approach prevented a potentially catastrophic hemorrhage despite initial underestimation of blood loss.
Implications:
- Highlights the importance of recognizing coagulopathy as a cause of PPH, even without visible bleeding.
- Emphasizes the utility of thromboelastometry in guiding transfusion therapy for obstetric coagulopathy.
- Underscores the value of a proactive, multidisciplinary approach in managing complex obstetric emergencies.
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