Srinivasan Aariya, Ikram Jibran, Ayad Sabry
Department of Anesthesiology Research Cleveland Clinic Foundation Cleveland Ohio USA.
Cleveland Clinic Foundation Cleveland Ohio USA.
Clin Case Rep. 2024 Dec 6;12(12):e9706. doi: 10.1002/ccr3.9706. eCollection 2024 Dec.
Placenta previa is the partial or complete covering of the internal os of cervix. It is one of the major risk factors for postpartum hemorrhage (PPH), maternal and neonatal morbidity and mortality. A 36-year-old G3P2 Jehovah's Witness female with a gestational age of 36 weeks 6 days and past medical history of chronic hypertension, T2DM, asthma, and past obstetric history of two cesarean sections, large for gestational age babies, and postpartum hemorrhage due to uterine atony, underwent an elective repeat low transverse cesarean section in view of posterior complete placenta previa, complicated by massive postpartum hemorrhage. The patient was immediately transported to the interventional radiology (IR) for uterine artery embolization (UAE) after unsuccessful treatment attempts with uterotonics and JADA system (vacuum induced uterine tamponade). In view of rapidly progressing bleeding, the decision was made for an urgent hysterectomy. Management of postpartum hemorrhage in a Jehovah's Witness patient is particularly complex as these patients refuse administration of blood products and involves medical, ethical, and legal implications.
前置胎盘是指宫颈内口部分或完全被覆盖。它是产后出血（PPH）、孕产妇和新生儿发病及死亡的主要危险因素之一。一名36岁、孕3产2的耶和华见证会女性，孕龄36周6天，既往有慢性高血压、2型糖尿病、哮喘病史，既往产科史包括两次剖宫产、巨大儿以及因子宫收缩乏力导致的产后出血，因后壁完全性前置胎盘行择期再次低位横切口剖宫产，并发大量产后出血。在用宫缩剂和JADA系统（真空诱导子宫压迫）治疗失败后，患者立即被送往介入放射科（IR）进行子宫动脉栓塞术（UAE）。鉴于出血迅速进展，决定紧急行子宫切除术。耶和华见证会患者的产后出血管理特别复杂，因为这些患者拒绝输注血液制品，涉及医学、伦理和法律问题。
