Difficult Caesarean Section with Massive Blood Transfusion, Abdominal Packing and Second Look Surgery: A Case Report

Liman Idris M*, Bello S, Babandi Rukayya M, Durojaiye Korede W, Oladepo Suleiman O, Okoye Uchenna E and Ya’u Gagarawa A

1Department of Obstetrics and Gynaecology, National Hospital Abuja (NHA), Nigeria 2Department of Surgery, National Hospital Abuja (NHA), Nigeria

^*Correspondance to: Liman Idris M 

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Abstract:

We present a 46-year old Diabetic woman with 3 previous myomectomies, caesarean section and appendectocmy; who had in-vitro fertilization - conceived pregnancy and an elective caesarean section at 35 weeks, gestation, complicated by recalcitrant primary postpartum haemorrhage, and managed by massive blood transfusion, damage control measures and a second look surgery. She booked for antenatal care at 10 weeks gestation with BMI = 30.47kg/m2, Fasting blood sugar =10.1 mmol/l and normal urinalysis. Her diabetes was controlled on insulin throughout her12 antenatal visits. On examination she was healthy-looking with normal vital signs and a midline infra umbilical scar; compactible fundal height of a singleton foetus with heart rate of 148 bpm. She had elective caesarean section with findings of dense pelvic adhesions, a partial rupture of the anterior uterine wall and a live female foetus with a birth weight of 2.5kg, good Apgar scores; and estimated blood loss of 1.5litre. Three units of blood were transfused intra-operatively. She was noticed to be bleeding per vagina with a non-contracting uterus despite oxytocin infusion. Immediately re-explored, subtotal hysterectomy done but haemostasis was unsuccessful despite multidisciplinary team approach. Abdomen was packed and closed. She had 12 units of blood, 2 units of fresh frozen plasma transfused and admitted to the intensive care unit. At the second-look surgery 72 hours later, packs were removed and haemostasis was satisfactory with a healthy-looking bowel. The abdomen was closed and patient recovered to intensive Care Unit. She responded well, was discharged on the 12th day post-operative (PCV=31%) after 19 units of blood and 2 units of FFP transfusion. In conclusion,severe postpartum haemorrhage from dense adhesions of previous abdominal surgeries in caesarean section is life-threatening. Our experience showed that available blood transfusion and intensive care services; and early triger of multidisciplinary care are key to a successful outcome.

Keywords:

Difficult Caesarean section; multiple transfusions; abdominal packing; second look surgery; Near-miss

Cite the Article:

Liman Idris M, Bello S, Babandi Rukayya M, Durojaiye Korede W, Oladepo Suleiman O, Okoye Uchenna E, et al. Difficult Caesarean Section with Massive Blood Transfusion, Abdominal Packing and Second Look Surgery: A Case Report. Ann Clin Case Rep. 2025; 10: 2757..