Progressive detachment of the normally located placenta: the clinical case of failed maternal death in massive blood loss

Abstract

Introduction. Despite the global achievements of obstetric science and practice, massive bleeding with premature progressive detachment of the normally located placenta, as well as in placenta previa and ingrowth, hypotonic bleeding, occupy one of the leading positions in the structure of obstetric bleeding and are associated with high rates of nearly dead women (near miss), with maternal and perinatal morbidity and mortality. The purpose of the study was to demonstrate the effectiveness of organizational methodology of emergency care in a 24-hour hospital using the clinical example of PPCR with atypical clinical picture, massive obstetric hemorrhage, and favorable outcome for the patient. Materials and methods. Material for the analysis of the clinical case was an exchange and notification card of a pregnant woman and a parturient and a labor history. Methods: anamnestic data analysis based on the study of official documentation of pregnancy and its outcome, peculiarities of delivery and labor outcome. Results. The analysis demonstrates the possibility of a rapid diagnosis of PPDNLP, which proceeded without the classical triad of symptoms, with a severe course, massive obstetric hemorrhage and timely specialized care, which led to a favorable outcome for the patient. Discussion. The speed of care on admission to the hospital, the timeliness of the correct diagnosis even in the absence of the classical clinical picture of PPDNLP, the equipment of the maternity hospital, the timely and adequate obstetric tactics allowed to avoid maternal mortality in massive blood loss and the presence of the disseminated internal coagulation (DIC) syndrome, complicating PPDNLP. Further study of mechanisms of formation, determination of the most significant predictors and triggers of PPDNLP, improvement of organization of care and planned trainings should make a certain contribution to the improvement of maternal and perinatal morbidity and mortality. Conclusion. In the maternal mortality rate reduction vector, an effective organizational technology of care is demonstrated in a case of PPONR with an atypical clinical picture, the presence of massive obstetric hemorrhage, which ended favorably for the patient.