Final FRCA-Nov.2012

MDMZ

A 28-year-old primipara presents for an emergency laparotomy 7 hours after an emergency lower segment Caesarean section (LSCS) for failure to progress. She was on an oxytocin infusion for 7 hours, and a 4.38 kg foetus was delivered. She had a large post-partum haemorrhage and uterine clots have been evacuated since delivery. At presentation she is pale and very anxious.

Examination
Heart rate: 140 bpm
Blood pressure: unrecordable
Pulse oximetry: not picking up trace
Carotid pulse: palpable.

Blood results before LSCS:
Haemoglobin: 13 g/dl
Platelets: 235 × 109/L
Other blood results unremarkable

Blood results after LSCS:
Haemoglobin: 2.8 g/dl
Platelets: 84 × 109/L
Prothrombin time: 19 s
Activated partial thromboplastin time ratio: 1.8
Fibrinogen 1.7 mg/dl
K+: 5 mEq/L

Chest X-ray: Bilateral infiltrates consistent with acute respiratory distress syndrome (ARDS).