Background and Aims Postpartum haemorrhage (PPH) is a leading cause of maternal mortality in developed and developing countries. It accounts for 25% of all maternal deaths. Uterine circulation is generally improved by epidural analgesia.
Methods 35 year old healthy multipara in term was scheduled for vaginal delivery and has had an epidural catether inserted receiving bolus doses of Ropivacaine 0,2%.This was patient‘s fifth childbirth. She had Ceasarean section before and epidural analgesia for vaginal delivery as well.
Results The patient was haemodynamically stable during all birth stages.
After spontaneous vaginal delivery and placental removal the patient started to bleed excessively from the uterus.
First laboratory results showed Plt 60 and coagulation parameters showed signs of DIC (PT 16, APTT 69,3, fibrinogen < 0,4)
Obstetrics team concluded the bleeding was due to uterine atony and carried out according to the protocol. The patient received oxytocin, tranexamic acid, prostaglandine derivates and balloon tamponade was performed. Total average blood loss was about 3 litres.
Intensive therapy included administration of fresh frozen plasma, cryoprecipitate, red blood cells concentrates, platelets and recombinant factor VII.
During all obstetrical procedures the patient was in full contact, haemodynamically stable, there weren’t neurological signs observed and pain relief was managed by the epidural catether. The patient had one hypotensive episode which was corrected with single administration of Phenylephrine.
Conclusions After administration of 1 mg of recombinant factor VII the patient’s bleeding has stopped instantly with improved laboratory coagulation results, thus earlier decided urgent hysterectomy procedure was prevented and there weren’t complications of epidural analgesia.