Postpartum Hemorrhage et causa Atonia Uteri and Ruptured Portion with Complications of Shock Hemorrhagic and Anemia: A Case Report from Southwest Sumba, East Nusa Tenggara

Abstract

Postpartum hemorrhage is one of the most common obstetric emergencies, and it is the most significant contributor to maternal mortality in the world. The most common cause is uterine atony, followed by laceration in the perineum or portion. P4A0 spontaneous postpartum at the primary health care facility (Puskesmas), a baby boy with a birth weight of 3000 grams cries spontaneously. After delivering the baby, the placenta was born 15 minutes later, with active bleeding afterwards of more than 1500 cc without uterine contractions. The patient was then diagnosed with spontaneous postpartum P4A0 with uterine atony, and the management of uterine atony was performed by massaging the fundus with external and internal bimanual compression, accompanied by fluid resuscitation by inserting a 2-line IV line. She was then given vaginal misoprostol, but contractions were still absent. She was then given a uterotonic drip of oxytocin (30 iu/30 dpm), and the contractions are getting better and stronger. Bleeding was evaluated, but still active then exploratorium on the birth canal and the source of the bleeding was found to be a portion of the tear from front to back, towards 5 o'clock. Then stitching was performed on the portion, and 1 hour after suturing, the bleeding was no longer active. The patient was treated at Puskesmas, with a final HB of 7.5 g/dL. To improve diagnosis accuracy and speed in handling emergency obstetric cases. Atonia uteri is caused by many factors, one of which is parturition as experienced by the patient. After active management of stage 3, bleeding continues, so that treatment is given, including the administration of crystalloid fluid, uterotonics, uterine massage, bimanual compression, and catheter condom placement. If the steps that have been taken have not stopped the bleeding, then the next intervention must be immediately taken, namely surgery. In cases of postpartum hemorrhage caused not by uterine atony but by a wound or tear in the portion, prompt actions must be taken to immediately eliminate bleeding by exploring and sewing the torn part and then re-evaluating to ensure that the bleeding stops. Establishing the right diagnosis in emergency cases of postpartum hemorrhage and providing prompt and appropriate treatment can prevent complications ranging from shock to death.