Emergency Medical Services
Albert Hardy Wu; Mariza Fitriati; Disa Edralyn; Adriana Jardine
Volume 9, Issue 2 , July 2023, , Pages 142-145
Abstract
Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating 2–4% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. ...
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Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating 2–4% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. Rhesus (Rh) is the second most significant blood group systemafter ABO. Hence, this blood type system needs to be taken into consideration. Furthermore, inIndonesia, Rh-negative blood types are rare.Case Presentation: A 39-year-old woman with Gravida IV, three term pregnancies, no pretermpregnancies, no abortions, and three living children (GIVP3003) and gestational age 26 to 27weeks arrived at the hospital with massive bleeding from the birth canal three hours beforeadmission. The bleeding was fresh red, and the patient had changed diapers twice before arrivingat the hospital. She presented hypovolemic shock, a blood pressure of 71/39 mm Hg, andanemic conjunctivas, with a history of B Rh (-) blood type, ongoing HIV therapy, and completedpulmonary tuberculosis (TB) treatment. The hospital’s and PMI’s (Indonesian Red Cross) bloodbank had no Rh (-) bloodstock. An emergency cesarean section under general anesthesia wasperformed, and a 900 g neonate was delivered. The patient received a total of four stored wholeblood (SWB) bags of type B Rh (+) blood products, one SWB bag during surgery, and three SWBbags during recovery in the intensive care unit (ICU).Conclusion: Rh (+) transfusion in patients with Rh (-) should be the last option in an emergency.The transfusion reaction did not occur right away in the initial transfusion. Under promptmanagement, the transfusion response and the life-threatening condition were then successfullymanaged.