30 Something Baby Doc

Nothing frightens an Obstetrician more than a patient with post-partum hemorrhage (heavy and profuse bleeding after a delivery). Unfortunately that's what I has to contend with last week. I was called to the room of a 20 year old patient who had underwent a c-section earlier that morning. When I arrived at the room , the patient had a seizure like episode, she was pale with a low blood pressure. I examined the patient and saw she had a considerable amount of bleeding, passing large amounts of blood and clots from her vagina. I felt her uterus and noted that it was soft. She had uterine atony which is a condition after delivery when the muscles of the uterus don't contract as expected inoder to slow bleeding after the baby is delivered. I asked the nurses to give pitocin (an intravenous medication that helps the uterus to contract) to the patient. Her bleeding stopped. Her blood counts were also very low from her blood loss, so she was given a blood transfusion.

The patient and her family were very concerned because her mother had died giving birth to her brother 15 years ago and the circumstances were very similar. The patient was convinced she would die the same way as her mother.

several hours went by and the residents called to tell me the patient has started bleeding again. We performed a bedside ultrasound the show lots of material inside the uterus that could have been placenta (afterbirth) that was left behind the latter would explain her heavy bleeding.

We rushed the patient back to the OR to performed a suction & curettage (an procedure that uses a long plastic tube attached to a vacuum inorder to clean out the uterus of all contents. We performed the s & c but didn't get much placenta out , only blood and clot. The patients vaginal bleeding was steadily increasing and pooling on the floor. The anesthesiologist was giving the patient medication inorder to keep her low blood pressures from falling even more. I notice the the once dry bandages on the patients abdomen from her C-section early were now soaked with blood. The patient was going into DIC (Disseminated Intravascular Coagulation - a condition where the material in our blood that help us form clots to keep use from bleeding out cease to function properly) The patient was going to die if we couldn't get her vaginal bleeding stopped.

The Catch: Normally in this situation we would perform an emergency hysterectomy to remove the uterus and stop the bleeding once and for all. Because of the DIC, and her inability to clot her blood, a hysterectomy would kill her. We had to stop her bleeding long enough to stabilize. We tried to pack her womb with gauze to stop the bleeding, the gauze just became soaked with blood and the patient continue to bleed.

One of the nurse showed me a device that had just arrive on out labor and delivery unit. It was a long balloon on a catheter that is inserted into the womb and inflated to tamponade (stop) the bleeding. I said to myself "why not" Not to mention I was out of options I read the instructions right there in OR . We inserted the balloon and the damn thing worked. The bleeding stopped and we transferred the patient to the ICU inorder to transfuse her more blood and replace her clotting factors in order to resolve her DIC.

The next day the patient was doing well. She was awake and alert and her blood counts had improved. We removed the balloon device from her uterus after 12 hours and she had no more vaginal bleeding. We were able to discharge her from the hospital with her baby this weekend.