Perioperative management of critical obstetric hemorrhage after cesarean delivery in a patient with hereditary hemorrhagic telangiectasia: a case report.

Abstract

Background: Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder associated with hemorrhagic complications. In pregnant women with HHT, postpartum hemorrhage can be life-threatening and may necessitate hysterectomy.

Case presentation: A 36-year-old primigravida woman with HHT underwent emergency cesarean delivery due to nonreassuring fetal status. Following delivery, she developed massive uterine bleeding. Despite intrauterine balloon tamponade, hemorrhage persisted. Under the direction of the attending anesthesiologist and obstetrician, maternal resuscitation was initiated. Contrast-enhanced computed tomography revealed active extravasation from the right uterine artery. During emergent interventional radiology, angiography identified contrast extravasation from a hypertrophied spiral artery at the peripheral end of the right uterine artery, and embolization achieved initial hemostasis. She subsequently received intensive care under the supervision of the critical care team and ultimately recovered without hysterectomy.

Conclusions: Rapid multidisciplinary intervention for critical obstetric hemorrhage in a patient with HHT led to maternal survival and uterine preservation.