DR RATHNA A,DR NIVEDITA
DOI: https://doi.org/Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Atonic PPH, characterized by failure of the uterus to contract effectively after delivery, is often refractory to conventional measures and may necessitate massive transfusion.
Case Presentation: We report the case of a 42-year-old woman with dichorionic diamniotic (DCDA) twin gestation conceived through in vitro fertilization who developed severe atonic PPH during elective lower segment cesarean section. Despite the use of standard uterotonic and surgical measures, she required aggressive resuscitation with crystalloids, colloids, multiple blood components, and pharmacologic agents. A structured massive transfusion protocol was activated early in the intraoperative course, which included balanced transfusion of red blood cells, fresh frozen plasma, and platelets, supported by vasopressors, tranexamic acid, calcium supplementation, and mechanical ventilation.
Management and Outcome: The patient received six units of packed red blood cells, six units of fresh frozen plasma, six units of platelets, four crystalloids, two colloids, tranexamic acid, vasopressors, and adjunctive supportive therapy. Active warming measures were instituted to prevent hypothermia, and metabolic acidosis was corrected with sodium bicarbonate. The patient was stabilized postoperatively in the intensive care unit, weaned from ventilatory support, and discharged in good condition without evidence of coagulopathy or organ dysfunction.
Conclusion: This case emphasizes the importance of early recognition of high-risk patients for PPH, prompt initiation of massive transfusion protocols, and meticulous hemodynamic and coagulation monitoring. Strict adherence to structured transfusion strategies, along with multidisciplinary coordination, can significantly reduce maternal morbidity and mortality in life-threatening obstetric hemorrhage.
