A case report: placental abruption complicated by disseminated intravascular coagulation, atonic postpartum hemorrhage, massive transfusion and obstetric hysterectomy

Abstract

Placental abruption is a potentially life-threatening obstetric emergency caused by premature separation of the placenta from the uterine wall. Severe abruption may be associated with intrauterine fetal death, disseminated intravascular coagulation (DIC), major hemorrhage and renal or other organ dysfunction. The case represents a 25-year-old G6P5L5 woman at 35 weeks and 6 days of pregnancy who presented with severe abdominal pain and absent fetal movements. Clinical assessment and ultrasonography were consistent with placental abruption with intrauterine fetal death and a large retroplacental clot. Laboratory evaluation showed severe anemia and features of coagulopathy. Emergency lower-segment cesarean section was undertaken. A male baby was delivered by vertex presentation but did not cry after birth. Approximately 1500 ml of retroplacental clots were removed, and the uterus was found to be floppy and atonic. Obstetric hysterectomy was performed for definitive control of hemorrhage. The patient required extensive transfusion of blood and blood products, was managed for DIC, remained vitally stable after resuscitation, and was discharged on postoperative day 11. This case emphasizes rapid recognition, prompt operative management, aggressive correction of coagulopathy, and timely definitive control of severe obstetric hemorrhage.