Dr.Faikover 7 years ago

Internal hemorrhaging in a 34 week pregnant woman - management?  

A 5004, prev 3 CS, pregnant 34 weeks, placenta complete centralis, total increta, presents with severe lower abdominal pain. The patient refused surgery when councilled about the risk of NICU admission. She collapsed at the door and was rushed to the OR. Portable US in the OR fetal bradycardia. Immediate intubation, midline incision. Massive Internal hemorrhage and a LIVE baby. Bilateral internal iliac A. ligation, then hysterectomy. Blood loss 1.5 litre hbo pre 12, post 8 gm%. Urologic morbidity minor bladder serosal tear Smooth post-op course.