[Case of atonic bleeding managed by emergency total hysterectomy and mass blood transfusion right after the cesarean section].

A 34-year-old woman, who had had atonic bleeding six years ago, had selective cesarean section under CSEA. On the operation, atonic bleeding occurred and persisted. Though we used uterine contracting agents (oxytocin, ergometrine), the bleeding volume exceeded 2,000 ml and the examination revealed Hb 5.9 g x dl(-1), Ht 19%. We decided to perform emergency hemostatic operation (total hysterectomy) under general anesthesia. During the emergency operation, total blood loss was 5,810 ml and total urine was 205 ml. We transfused packed red cell 16 units, FFP 10 units, and infused fluid 4,650 ml. After the operation, the examination revealed Hb 9.7 g x dl(-1), Ht 27.8%, Plt 7.0 x 10(4) x microl(-1) and obstetric DIC score 10. The patient was treated in ICU under intubation, with anti-DIC drug (ulinastatin 50,000 units). Next day, she was extubated and admitted to the maternity ward. She was discharged on the 7th postoperative day without any complications. In 2010, guideline for obstetric critical hemorrhage was published. The guideline recommends the importance of observing the perioperative change of vital sign (e. g. shock index) and obstetric DIC score. In the obstetric critical hemorrhage, we should take proper and prompt actions in accordance with this guideline.