Anaesthetic management of atonic postpartum haemorrhage secondary to trauma during normal vaginal delivery: A case report

PPH is a leading cause of maternal mortality which has several aetiologies. Effective management including resuscitation, hemostasis, and identification and treatment of the cause in these cases is important. This case reports a parturient patient G4P3L3 40 weeks and 1 day gestation who suffered from PPH after normal vaginal delivery. On exploration an uncommon right broad ligament hematoma was detected which was drained, ligating the hypogastric artery. A hysterectomy was performed. During the procedure general anesthesia with ketamine was administered. Haemostasis was maintained by transfusing 2 units of packed red blood cells and 1 unit of fresh frozen plasma (FFP). Inj Fibrinogen 2 grams and Inj. Tranexamic acid 1 gram was infused intravenously. In total, 9 units of packed RBCs, 6 units of FFP, 4 units of platelets, and 2 liters of crystalloids were transfused during the entire procedure. 10 ml of 10 % calcium gluconate was also given after every 3 units of packed RBC transfusion. The patient was weaned off the ventilator after stabilizing the vitals and discharged 5 days later.