06/07/2024
Title: maternal near miss
Comprehensive Management of Postpartum DIC with Severe Hemorrhage, Cervical Tear Extending to Uterine Artery, Acute Kidney Shutdown: Successful Preservation of Uterus, Renal Function, and Maternal Health
Abstract:
This case report presents a complex obstetric case involving a postpartum patient with disseminated intravascular coagulation (DIC), severe hemorrhage, a cervical tear extending to the uterine artery, and acute kidney shutdown. Through a multidisciplinary approach encompassing resuscitation, meticulous surgical repair of the cervical tear and uterine artery, vessel clamping, specialized renal support, and comprehensive care, the patient was successfully stabilized, and both uterine and renal function were preserved. This case underscores the critical importance of integrated care, surgical expertise, and innovative interventions in managing high-risk obstetric emergencies with multi-system involvement thus preventing maternal near miss.
Case Presentation:
A 21 year-female Second gravida ,postpartum patient refered from two hospitals presented with signs of DIC, profound traumatic postpartum hemorrhage, and acute kidney shutdown, complicated by a cervical tear extending to the uterine artery with bakri balloon in situ.The patient's critical condition demanded urgent intervention to address the complex obstetric, coagulation, and renal challenges. A thorough evaluation revealed the need for immediate resuscitation, surgical exploration, repair of the cervical tear and uterine artery, vessel clamping, and specialized renal support to optimize maternal outcomes.
Management and Interventions:
A multidisciplinary team comprising obstetricians, hematologists, nephrologists, vascular surgeons, anesthesiologists, and surgical specialists collaborated to develop a tailored management strategy. Aggressive resuscitation measures with massive blood and blood products transfusion were initiated to stabilize the patient's hemodynamics, followed by meticulous surgical exploration to identify and repair the cervical tear extending to the uterine artery. Vaginally,Vascular clamping and de vascularisation techniques were employed to achieve hemostasis, while specialized renal support was integrated to address the acute kidney shutdown and ensure renal function.
Postoperative Care and Follow-Up:
Following successful surgical interventions, including repair of the cervical tear and uterine artery, and specialized renal support, the patient underwent close monitoring in the postoperative period for signs of ongoing bleeding, consumption coagulopathy, and renal function recovery. Comprehensive postoperative icu care, including hemodynamic stabilization, renal replacement therapy, and meticulous monitoring, was crucial in facilitating the patient's recovery and optimizing outcomes. Subsequent assessments confirmed the successful preservation of uterine and renal function, with the patient demonstrating improved clinical status and renal recovery.
Conclusion:
This case exemplifies the intricate management of a postpartum patient with DIC, severe post partum hemorrhage, a cervical tear extending to the uterine artery, and acute kidney injury, requiring a multidisciplinary approach and advanced surgical interventions. Through collaborative care, surgical expertise, and innovative strategies, it is possible to achieve positive outcomes, preserve uterine and renal function, and ensure maternal health in complex obstetric emergencies with multi-system involvement. This case underscores the critical role of teamwork, innovation, and comprehensive care in addressing high-risk obstetric conditions with multi-system complications thus preventing maternal near miss and saving the uterus.
Keywords: Disseminated intravascular coagulation, Postpartum hemorrhage, Cervical tear repair, Uterine artery injury, Acute kidney shutdown, Multidisciplinary collaboration, Maternal-fetal outcomes, Renal support, maternal near miss.
