Manajemen Perdarahan Masif di Bidang Obstetri: laporan kasus

Fajar Narakusuma; Kadek Agus Heryana Putra; Tjokorda Gde  Agung Senopathi

doi:10.15562/medicina.v52i1.1040

Manajemen Perdarahan Masif di Bidang Obstetri: laporan kasus

Fajar Narakusuma ,

Kadek Agus Heryana Putra ,

Tjokorda Gde Agung Senopathi ,

PDF |
DOI: https://doi.org/10.15562/medicina.v52i1.1040 |
Published: 2021-04-01

Abstract

Background: Management of a complicated obstetric patient with profuse bleeding following caesarean section required massive blood transfusion was managed properly with multidisciplinary approach in ICU. The involvement of obstetrician, anesthesiologist and intensivist as a team in a single setup is essential for the management of such patients and the best outcome. The patient received total 15 units of blood products among which 5 units packed red blood cell, 5 units of fresh frozen plasma and 5 units of platelet concentrate. Despite this massive bleeding, the patient recovered fully with minimal complications as we follow the standard blood transfusion protocol

Case: 37-year-old woman came to the Maternity Hospital of Sanglah Hospital with complaints of vaginal bleeding since one hour before. The patient was diagnosed with a pregnancy diagnosis with suspected placenta previa totalis adhesive. Patients underwent Caecarian Sectio surgery followed by a hysterectomy procedure resulting from postoperative bleeding. Durante surgery carried out massive blood transfusions and after surgery performed in intensive care with a ventilator

Latar belakang: Penatalaksanaan pasien obstetri yang rumit dengan perdarahan masif saat operasi caesar diperlukan transfusi darah masif dikelola dengan baik dengan pendekatan multidisiplin di ICU. Keterlibatan ahli kebidanan, anestesi, intensivist sebagai tim dalam satu kesatuan sangat penting untuk manajemen pasien seperti itu dengan hasil terbaik. Pasien menerima total 15 unit produk darah di antaranya lima unit PRC darah simpan, lima unit fresh frozen plasma dan lima unit konsentrat trombosit. Meskipun perdarahan masif, pasien pulih sepenuhnya dengan komplikasi minimal saat kami mengikuti protokol transfusi darah standar.

Kasus:. Perempuan 37 tahun datang ke Ruang Bersalin RSUP Sanglah dengan keluhan perdarahan pervaginam sejak satu jam sebelumnya. Pasien diketahui dengan diagnosa kehamilan dengan placenta previa totalis suspek adhesive. Pasien dilakukan operasi Sectio Caecarian yang dilanjutkan dengan prosedur Histerektomi akibat dari perdarahan pasca operasi. Durante operasi dilakukan transfusi darah masif dan paska operasi dilakukan perawatan di ruang intensif dengan ventilator

References

American College of O, Gynecologists, Society for Maternal-Fetal M, et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210(3):179-93. doi: 10.1016/j.ajog.2014.01.026 [published Online First: 2014/02/26]
Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol 2015;28(3):275-84. doi: 10.1097/ACO.0000000000000180 [published Online First: 2015/03/27]
MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma 2003;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF [published Online First: 2003/07/12]
Vlaar AP, Juffermans NP. Transfusion-related acute lung injury: a clinical review. Lancet 2013;382(9896):984-94. doi: 10.1016/S0140-6736(12)62197-7 [published Online First: 2013/05/07]
Mair DC, Eastlund T. The pathophysiology and prevention of transfusion-related acute lung injury (TRALI): a review. Immunohematology 2010;26(4):161-73. [published Online First: 2010/12/01]
Benson AB, Moss M, Silliman CC. Transfusion-related acute lung injury (TRALI): a clinical review with emphasis on the critically ill. Br J Haematol 2009;147(4):431-43. doi: 10.1111/j.1365-2141.2009.07840.x [published Online First: 2009/08/12]
Sperry JL, Ochoa JB, Gunn SR, et al. An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion. J Trauma 2008;65(5):986-93. doi: 10.1097/TA.0b013e3181878028 [published Online First: 2008/11/13]

[1] American College of O, Gynecologists, Society for Maternal-Fetal M, et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210(3):179-93. doi: 10.1016/j.ajog.2014.01.026 [published Online First: 2014/02/26]

[2] Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol 2015;28(3):275-84. doi: 10.1097/ACO.0000000000000180 [published Online First: 2015/03/27]

[3] MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma 2003;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF [published Online First: 2003/07/12]

[4] Vlaar AP, Juffermans NP. Transfusion-related acute lung injury: a clinical review. Lancet 2013;382(9896):984-94. doi: 10.1016/S0140-6736(12)62197-7 [published Online First: 2013/05/07]

[5] Mair DC, Eastlund T. The pathophysiology and prevention of transfusion-related acute lung injury (TRALI): a review. Immunohematology 2010;26(4):161-73. [published Online First: 2010/12/01]

[6] Benson AB, Moss M, Silliman CC. Transfusion-related acute lung injury (TRALI): a clinical review with emphasis on the critically ill. Br J Haematol 2009;147(4):431-43. doi: 10.1111/j.1365-2141.2009.07840.x [published Online First: 2009/08/12]

[7] Sperry JL, Ochoa JB, Gunn SR, et al. An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion. J Trauma 2008;65(5):986-93. doi: 10.1097/TA.0b013e3181878028 [published Online First: 2008/11/13]

Manajemen Perdarahan Masif di Bidang Obstetri: laporan kasus

Abstract

References

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