Postpartum Haemorrhagic Shock: Successfully Treated with Auto-Transfusion Tourniquet—A Case Report with Shock Index

Background. The incidence of postpartum haemorrhage in the US is nearly 2% and increasing. The mortality rate from the blood loss is 8% domestically and 20% globally despite obstetric, hormonal and resuscitative measures. There is a need for simple, quick and readily available new means to reverse the shock, particularly in under-served remote areas. Case. Twenty-one-year-old G1 P0 had an essentially normal delivery with normal vital signs, but placenta was retained for 22 minutes. Atony and aggressive vaginal bleeding were noted with drop of blood pressure (BP) to 63/37 mmHg and tachycardia to 147 beats per minute (bpm) (shock index = 147/63 = 2.33). IV fluids and Pitocin 20 mg IV had no effect on bleeding or BP. An auto-transfusion tourniquet (A-TT), (HemaShock, OHK Medical Devices, Tirat Carmel, Israel) was placed on one of her legs. Within 1 minute blood pressure started to increase and heartrate slowed. Ten minutes after applying the A-TT the placenta was delivered, vital signs stabilized, and bleeding slowed down and gradual removal of A-TT was started. Blood transfusion was not readily available in this rural hospital. Patient and newborn were flown to a medical centre and were discharged the next day in good condition. Conclusion. The prompt effect of the A-TT in this case in restoring hemodynamic status of the patient suggests that the treatment of hypotension facilitated restoration of blood flow to the myometrium smooth muscle, bringing to it both oxygen and metabolites and the short-acting Pitocin, resulting in reversal of the uterine atony and intrinsic haemostasis. While massive postpartum blood loss leads to shock and hypotension, it is also known that hypotension causes atony, whereby a vicious cycle develops. The use of A-TT can break this cycle, help the uterus contract, expel a retained placenta and restore the wellbeing of the patient. Additional studies on the use of A-TT in the urgent care of postpartum haemorrhage are warranted.