However, the second interventional radiology (IVR) was required to control bleeding from the vagina. The fibrinogen level increased above 100 mg/dL after hysterectomy. The time from the start of surgery to hysterectomy was 11 min. In spite of those treatments, her bleeding was uncontrollable and obstetrics team decided to perform total hysterectomy, and the patient was transferred to the operating room. Red blood concentrates (RBCs) and fresh frozen plasma (FFP) were transfused using a rapid infusion system. Uterine artery embolization was performed at radiology department. Besides administering low-dose noradrenaline, an occlusion balloon was inserted into the descending aorta. We ruled out pulmonary embolism because the central venous pressure was 5 mmHg. She was orotracheally intubated, and a central venous and a radial artery catheter was inserted. We started treatment based on a suspicious diagnosis of AFE due to sudden decrease of plasma fibrinogen level and uncontrollable bleeding from a needle hole. At 30 min after the delivery, the total bleeding amount reached 3100 mL, and the blood pressure was decreased to 72/43 mmHg, shock index increased to 2, and SpO 2 decreased to 86%. We started to transfuse red blood cells and placed an intrauterine (Bakri®) balloon. Blood pressure was 112/89 mmHg, heart rate was 80 beats per minute, shock index was 1, and total amount of bleeding was 2800 mL at that time. Total delivery time was 2 h and 39 min (second stage of labor duration was 22 min).Īfter an episiotomy, a large amount of bleeding from the uterus was observed, and the obstetric physician suspected it as postpartum atony. Patient delivered a female infant weighing 2468 g with an Apgar score of 7/8. There were no major complications until fetal bradycardia (80–90 beats per minute) occurred, which prompted the obstetric physician to go for vacuum extraction delivery. Due to polyhydramnios, pinhole amniotomy was performed at cervix dilation of 3 cm. Then, the labor analgesia was managed by programmed intermittent epidural bolus with 0.1% ropivacaine and fentanyl 2 mcg/mL was set at 8 mL with a 60-min interval. A catheter was introduced into the epidural space at cervix dilatation of 4 cm. The combined spinal-epidural block was placed at 元-L4 level, and 1.5 mg 0.5% isobaric bupivacaine with fentanyl 15 mcg was administered into the subarachnoid space. A 39-year-old, gravida 2, para 1, Japanese woman (158 cm/56.8 kg) with fetal congenital heart anomaly and polyhydramnios was scheduled for induction of delivery at 37 weeks of gestation.
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