2024 Volume 60 Issue 2 Pages 266-270
In Aomori Prefecture, due to its geographical features and climatic conditions, there are delivery facilities that require time for transport to a perinatal center, and appropriate measures are especially required for patients with critical obstetric hemorrhage.
We experienced a case of critical obstetric hemorrhage that could have been saved by appropriate cooperation between the hospital and the perinatal center. After forceps delivery at Clinic A, a patient with a vaginal wall laceration lost more than 2, 000 mL of blood, with resulting in a Shock index（SI）exceeding 2.0.
We judged that the patient’s life was likely to be endangered considering the time required for transport to our hospital. so we first ordered transport after emergency treatment to Hospital B, about 15 minutes from A. At B, pressure hemostasis using rolled gauze and blood transfusion were performed, and the patient was transported to our hospital after her condition was stabilized. When the gauze was removed after arrival, there was a large amount of arterial bleeding from the vaginal wall, and the SI > 2.0 was observed again. The patient was successfully treated with arterial embolization while receiving a pumping transfusion to stop the bleeding.
We were able to save her life through appropriate collaboration between Clinic A, Hospital B, and our hospital. In a perinatal environment such as our prefecture, hospital collaboration should be considered to save the life of the mother.
