A 34 year old primagravidae had an uneventful dichorionic diamniotic twin pregnancy, with normal fetal growth on ultrasound and both twins in a cephalic presentation. Labour was induced at 40 +5 weeks of gestation with vaginal prostaglandin and an epidural catheter was sited. The first twin was delivered by rotational forceps delivery for delay in the second stage of labour secondary to deep transverse arrest, and a right mediolateral episiotomy was made just before delivery. The second twin was delivered 19 minutes later by ventouse extraction for fetal distress using a silicone cup. The third stage of labour was actively managed and the uterus contracted well; however, following delivery of the second twin, profuse vaginal bleeding was noticed from the episiotomy site and two bilateral vaginal tears that extended to one-third of the length of the vagina. No other genital trauma was present and the vaginal lacerations and episiotomy were repaired without delay. The estimated blood loss was 1500 mL. A coagulation screen showed an isolated prolonged activated partial thromboplastin time of 61 seconds (control 34 seconds, normal range 36 -50 seconds), corrected to 48 seconds in vitro by a 50:50 mix with normal plasma. The haemoglobin concentration was 6.5 g/dl and the woman received a transfusion of five units of blood. The activated partial thromboplastin time following transfusion was 49 seconds. She had no history of bleeding following trauma or surgery, which included fractured tibia and fibula, spinal surgery for lumbar vertebral fracture and appendicectomy. There was no family history of a bleeding tendency. Clotting studies later indicated a low level of factor XI of 0.16 U/mL (normal range 0.7 -1.5 U/mL) and normal levels of factors VIII, IX and XII. This confirmed a diagnosis of factor XI deficiency. Lupus anticoagulant and antiphospholipid antibodies were not present. Postpartum recovery of the mother and both babies was uneventful with no neonatal bleeding complications and both infants had normal levels of factor XI. Case 2A 34 year old woman had an uneventful pregnancy. She was admitted with a nine-hour history of spontaneous rupture of the membranes at 39 weeks of gestation. Her previous delivery at another hospital was an emergency lower segment caesarean section for failed induction of labour following spontaneous rupture of membranes at 37 weeks of gestation. This was reported to be complicated by excessive blood loss although coagulation studies were not performed at the time. An appendicectomy was complicated by delayed wound haemorrhage on the second post-operative day. The wound required resuturing. She returned to theatre because of secondary haemorrhage following tonsillectomy and required a blood transfusion. Laser cone biopsy and diagnostic laparoscopy had been uneventful: her sister has bled following a diagnostic laparoscopy.A repeat caesarean section was planned when labour has not begun 24 hours after admission. A coagulation screen performed because of her bleeding history showed an i...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.