Obstetrics / Vaginal delivery
Postpartum haemorrhage following vaginal delivery
Adele achieved a full term normal delivery in her 3rd pregnancy, but persistent bleeding was noted after delivery of the placenta. The placenta was complete and an atonic uterus was diagnosed. Uterotonic drugs, including Syntocinon, Ergometrine and Haemabate, were given over several hours, but the bleeding continued and the patient became shocked. EUA and bimanual compression were carried out in theatre without resolving the problem and hysterectomy was performed. It was alleged, in court, that inadequate blood transfusion had allowed the claimant to become shocked and develop DIC, but PMS convinced the judge that this was a result of the uterine atony and not the main cause of the bleeding. He was persuaded that all reasonable conservative measures had been taken to stop the bleeding and that hysterectomy was necessary to save the patient's life.
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