Intra-aortic Balloon Pump for Cesarean Hysterectomy and Massive Hemorrhage in a Parturient with Placenta Accreta and Pulmonary Embolus.

During cesarean hysterectomy for a placenta accreta, a 36-year-old parturient underwent a massive resuscitation for profound bleeding and also suffered a pulmonary embolus leading to cardiac arrest. Chest compressions and epinephrine were required for resucitation. When surgery was complete, she was taken to the intensive care unit on an epinephrine infusion and inhaled nitric oxide but was brought back to the operating room after 3 h for surgical exploration. Echocardiography revealed a poorly contracting left ventricle, and an intra-aortic balloon pump was inserted. She gradually recovered full function and was discharged home after 35 days.

Knowledge of blood loss at delivery among postpartum patients.

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of obstetric morbidity. There is limited understanding of patients' knowledge about blood loss at delivery, PPH, and PPH-related morbidities, including transfusion and anemia. METHODS: We surveyed 100 healthy postpartum patients who underwent vaginal or cesarean delivery about blood loss, and whether they received information about transfusion and peripartum hemoglobin (Hb) testing. Responses were compared between women undergoing vaginal delivery vs. cesarean delivery; P < 0.05 considered as statistically significant. RESULTS: In our cohort, 49 women underwent vaginal delivery and 51 women underwent cesarean delivery. Only 29 (29%) of women provided blood loss estimates for their delivery. Women who underwent cesarean delivery were more likely to receive clear information about transfusion therapy than those undergoing vaginal delivery (43.1% vs. 20.4% respectively; P = 0.04). Women who underwent vaginal delivery were more likely to receive results of postpartum Hb tests compared to those undergoing cesarean delivery (49% vs. 29.4%; P = 0.02). CONCLUSION: Our findings suggest that women are poorly informed about the magnitude of blood loss at delivery. Hematologic information given to patients varies according to mode of delivery. Further research is needed to better understand the clinical implications of patients' knowledge gaps about PPH, transfusion and postpartum anemia.