NASG – As an Antepartum Lifesaviour
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 4
Abstract
Obstetric Hemorrhage (OH) Is The Leading Cause Of Maternal Mortality, Responsible For 25–50% Of Maternal Deaths [1]. Uncontrolled Hemorrhage Can Lead To Irreversible Hypovolemic Shock, Multiple Organ Dysfunction Syndrome, And Mortality. NASG Has Been Extensively Used In Patients With PPH But There Are No Reports For Its Use In Antepartum Period. Here We Report A Unique Case Of A Maternal Near Miss Who Survived Solely Because Of The Timely Use Of NASG. A 23 Year Old Primigravida Was Rushed To The ED In A State Of Shock, Gasping, No Pulse & BP Recordable With A History Of Sudden Onset Acute Pain Abdomen, Vomiting & Fainting Attack At Home 2 Hrs Ago. She Was 5 Months Pregnant. On Examination – She Was Cold & Clammy, Pale, Pulse & BP Not Recordable, Delirious And Not Following Verbal Commands. Abdominal Examination Revealed Tense-Tender Distension With Uterine Size Not Appreciable. A Provisional Diagnosis Of Ruptured Ectopic Pregnancy With Massive Intraperitoneal Hemorrhage Was Made. Simultaneous Resuscitative Efforts Were Started. Efforts Were Made To Secure An IV Line But Because Of The Shock We And Even The Anesthesiologist Were Unable To Insert An IV Cannula. We Nearly Thought We Were Going To Lose Her Then The Idea Of Using NASG For Stabilizing Her And Then Retry To Secure The IV Line Struck Us. Quickly NASG Was Brought And Applied To The Patient. To Our Surprise Patient Started Regaining Consciousness, Her Pulse Was Recordable On The Monitor And We Finally Succeeded In Establishing A Secure IV Line. Without Wasting Further Time She Was Shifted To Operation Theatre After Blood Samples Were Obtained For Routine Analysis And Grouping & Cross-Matching, Blood Bank Notified For Massive Transfusion Requirement. On Operation Table Under GA Only The Abdominal Segments Of The Garment (4,3,2) Were Removed To Provide Access For Surgery. Abdomen Was Entered Through A Pfannensteil’s Incision –There Was Massive Hemoperitoneum(=2500ml Of Nonclotting Blood & Few Blood Clots), Same Suctioned Out. We Quickly Searched For The Cause And Found That It Was A Right Sided Ruptured Non-Communicating Rudimentary Uterine Horn Which Was Profusely Bleeding With The Fetus Lying In Peritoneal Cavity & Placenta Insitu. Left Horn & Adnexa Were Normal. The Ruptured Horn With Placenta Was Excised After Clamp-Cut-Ligation Of The Base. The Vital Parameters Further Stabilized. Abdomen Closed Back After Achieving Complete Hemostasis, Instruments & Mop Counts Check. NASG Abdominal Segments Were Reapplied Soon After Completion Of The Procedure. Intra-Operatively 5units Of PRBC, 4 FFP & 4 Rdps Were Transfused. Slowly Our Patients’ Condition Showed Signs Of Improvement With Stabilizing Vital Parameters, Decreased Requirement Of Vasopressor Support & Urine Output Improved. She Was Kept In ICU For 24 Hrs. NASG Was Removed After 12 Hrs In A Proper Manner Once The Criteria Were Met. Further Recovery Was Uneventful & She Was Discharged On D6. After 1&3 Months Follow Up Visits She Is Healthy With No Complaints & Has Normal Periods.
Authors and Affiliations
Dr Indra Bhati, Dr Priyanka Choudhary, Dr Manisha Panwar
Keywords
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- EP ID EP370415
- DOI 10.9790/0853-1704031921.
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