[Five Cases of Anesthetic Management for Emergent Hysterectomy with Postpartum Hemorrhage after Vaginal Delivery].

Anesthetic management for emergent hysterectomy with postpartum hemorrhage after vaginal delivery is often difficult due to disseminated intravascular coagu- lation (DIC). Here we discuss our experience with 5 cases (2 in-hospital, 3 transferred to our hospital) of emergent hysterectomy after vaginal delivery. Preop- erative blood loss was 4,485±4,450 [1,404-12,350] ml, and blood loss during the operation was 7,466±5,543 [2,096-15,8561 ml. A total of 35±29 [10-80] units of red blood cell concentrates, 36±32 [4-84] units of fresh frozen plasma, and 60±47 [20-120] units of platelet concentrates were administered. The primary cause of massive hemorrhage was placenta accreta in 3 cases, cervical laceration in 1 case, and amniotic fluid embo- lism in 1 case. The progression of DIC before the operation was attributed to an escalation in hemorrhage. Physicians should note that massive hemor- rhage often occurs during emergent hysterectomy after vaginal delivery and make necessary prepara- tions for appropriate perioperative management.