Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetal
mortality worldwide, complicating 2–4% of pregnancies. Considering the probability of blood
transfusion, blood testing and cross-matching are essential for the anesthesiologist during
perioperative management. Rhesus (Rh) is the second most significant blood group system
after ABO. Hence, this blood type system needs to be taken into consideration. Furthermore, in
Indonesia, Rh-negative blood types are rare.
Case Presentation: A 39-year-old woman with Gravida IV, three term pregnancies, no preterm
pregnancies, no abortions, and three living children (GIVP3003) and gestational age 26 to 27
weeks arrived at the hospital with massive bleeding from the birth canal three hours before
admission. The bleeding was fresh red, and the patient had changed diapers twice before arriving
at the hospital. She presented hypovolemic shock, a blood pressure of 71/39 mm Hg, and
anemic conjunctivas, with a history of B Rh (-) blood type, ongoing HIV therapy, and completed
pulmonary tuberculosis (TB) treatment. The hospital’s and PMI’s (Indonesian Red Cross) blood
bank had no Rh (-) bloodstock. An emergency cesarean section under general anesthesia was
performed, and a 900 g neonate was delivered. The patient received a total of four stored whole
blood (SWB) bags of type B Rh (+) blood products, one SWB bag during surgery, and three SWB
bags 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 prompt
management, the transfusion response and the life-threatening condition were then successfully
managed.