PERIOPERATIVE MANAGEMENT OF

MASSIVE BLEEDING IN-BIRTH DELIVERY

(CASE SERIES) Paat Natalia Debora Algritha1, Helen Yudi Irianto2
1 Faculty of Medicine, Tarumanagara University, Jakarta, Indonesia
2 Department of Anesthesiology, Ciawi General Hospital, West Java,

Indonesia
BACKGROUND: OBJECTIVE:
Obstetric haemorrhage remains one of the major To discuss the presentation, diagnosis and
causes of maternal death in both developed and management of massive bleeding in birth delivery.
developing countries. Early recognition with accurate METHODOLOGY:
management allows for conservative measures, We describe a case series of four patients with massive
avoiding evacuation which may worsen the bleeding. bleeding in birth delivery, their subsequent and
Keywords: massive bleeding, obstetric haemorrhage. outcome from January – May 2019.
Age Clinical Blood Operation Blood
Case EWS (min) Support Outcome
(y.o) findings lose (L) procedure transfussion
1 31 PVB post SP, Nor epi : 0,3mcg
< 1 min Laparotomy Mother 
ROSC 2,5 4 FFP,4 PRC Epi : 0,3mcg
Hysterectomy Baby 
Dobutamine : 10mcg
2 29 PVB,
Abruptio SCTP + Mother 
2,5 4 min 2 FFP,8 PRC Nor epi : 0,1mcg
Placentae + Tubectomy Baby 
Atonia Utery
3 34 PVB SC + Mother 
1,5 4 min 6 PRC -
Tubectomy Baby 
4 42 PVB
+decreased SCTP + Mother 
2 2,5 min 5 FFP,5 PRC nor epi 0,1mcg
fetal Tubectomy Baby † Fig. 1 B-lynch suture or B-lynch
movement
PVB: Per vaginal bleeding; SP: Spontaneous partus; SCTP: section caesaria transperitoneal; SC: Sectio Caesaria; procedure for stopping the bleeding
FFP: Fresh frozen plasma; PRC: packed red cells; : lived ; †: death

Color definition:
Case 1
Case 2
Case 3
Case 4

Systolic
Diastolic

RESULTS: CONCLUSION: Time management

All patients present with MAP <65mm/Hg. Vaginal bleeding is a major
and coordination between related
complaint for patients. Within <5 minutes (EWS) patients were given
units (ER/Emergency Room,
preoperative PRC transfusion of 1-3 packs (PRC / FFP), with an additional 3-
OR/Operation Room, ICU/
5 packs (PRC/FFP) after surgery.
Intensive Care Unit, blood bank)
All patients underwent GA(General Anesthesia) with the MRSI technique.
reduce the risk of death in patients
It’s including preparation with statics and emergency medicine, monitoring
with massive bleeding in-birth
BP(Blood pressure), HR(Heart Rate), RR(Respiratory Rate), Saturation and IV
delivery. Hemodynamic
line. Continuous with 3 minute O2 pre-oxygenation with normal Tidal
monitoring and resuscitation in
volume, with 100% O2 using a mask. Afterwards, pre-treatment with fentanyl
massively bleeding patients,
2-3mcg/kg, and rocuronium 1.2mg/kg. Protection with a sellick maneuver,
affect outcomes.
placement the intubation with ETT (endotracheal tube) and confirmed by
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