![]() Pitocin infusion was instituted at full speed after placental delivery.Ī blood sample tested 14 minutes postpartum revealed a Hb of 9.9 g/dL, Hct 29.9%, Platelet 110× THSD/μL, Prothrombine time >150/10 seconds (8–12seconds), PT(INR) >10.0, and partial thromblastin time 39.7seconds (23–35seconds). No vaginal clots were observed at any point. The patient received one dose of methyl ergonovine maleate (0.2mg) intramuscularly and one dose of carboprost tromethamine (0.25mg) intramuscularly along with 1000 μg of misoprostol per rectum. The obstetrician noted steady and profuse noncoagulated uterine bleeding despite perineal laceration repair. The patient remained haemodynamically stable throughout the labour and delivered a healthy male baby. The labour course was uneventful without pitocin augumentation. ![]() She had taken no medication and had no known allergy. She was at 39 weeks gestation and was otherwise healthy. (b3) Arrow indicates vascular thrombi with lanugo hair(Haematoxylin– eosin stain, original magnification ×100).Ĭase 2: The patient was a 35-year-old female with gravida 3, para 1, and abortus 1. (b2) Arrows indicate the highlighted squames(Immunohistochemical stain for Cytokeratin, original magnification ×200). ![]() ![]() (b1) Arrows indicate presence of intravascular thrombi with squames (Haematoxylin– eosin stain, original magnification ×400). (a2) Arrows indicate fibrinoid and inflammatory exudates with lanugo hair (Haematoxylin– eosin stain, original magnification ×200). (a1) Arrows indicate vascular thrombi with laminated squames (Haematoxylin– eosin stain, original magnification ×200). The pathological findings confirmed our diagnosis of AFE and revealed multifocal thrombi with fibrinoid and inflammatory exudates, presence of keratinizing desquamated squamous cells and amorphous materials, and a rare lanugos hair-like structure within the vascular lumen of the cervix and lower uterine segment. The vital signs and laboratory data became stable after hysterectomy and transfusion of 14 units of packed RBCs, 12 units of fresh frozen plasma, 17 units of cryoprecipitate, and 12 units of platelets. Therefore, she received total abdominal hysterectomy because of persistent and uncoagulated bleeding. She was sent to the operative room for uterine curettage due to suspected retained placenta before the coagulation studies, but no abnormalities were found. Coagulation studies revealed a fibrinogen of 26.1 mg/dL, prothrombin time 32.9 seconds (8–12 seconds), Prothrombin International Normalised Ratio (INR) 3.57, partial thromboplastin time 41.7 seconds (23–35 seconds), Fibrinogen Degradation Product (FDP) 829.1 μg/mL (<5.0 μg/mL), D-Dimer 1162 μg/L (<324 μg/L), Hemoglobin (Hb) 7.6 g/dL, Hematocrit (Hct) 24.0%, and platelet count 101× THSD/μL. Her blood pressure was 80/48 mmHg, with a pulse rate of 120/minute, respiratory rate 20/minute, and body temperature 37.7☌. She presented with massive vaginal bleeding and physical examination revealed a soft uterus and uncoagulated blood in the vagina. The patient was transferred to our hospital one hour and 22 minutes after the bleeding episode. She developed profuse vaginal bleeding 1 hour and 10 minutes after delivery. Spontaneous vaginal delivery with normal neonatal outcome occurred after membrane rupture. Her prenatal care was normal and intrapartum course was smooth with no use of pitocin. Case 1: The patient was a 29-year-old female with gravida 3, para 2, and abortus1 who had a spontaneous full term vaginal delivery.
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