A Multidisciplinary Approach to a Hysterectomy: A Case Study
- Describe the importance of multidisciplinary involvement in obstetric emergencies.
- Identify 4 key health care team members outside the perinatal sphere whose participation in obstetric emergencies is vital for optimal maternal and fetal outcomes.
- Examine the structure of current emergency drills within your own organization and discuss methods in which to integrate other health care team members.
A postpartum hemorrhage (PPH) following a cesarean section can lead to rapid hemodynamic deterioration and requires immediate intervention. The key to successful management of a PPH is founded on the knowledge base and collaboration among multidisciplinary health care team members, not solely those of the perinatal realm. It is therefore vital to provide a multidisciplinary approach to PPH management and education, as demonstrated in the following case study.
Case:
A 23 year old gravid 4, para 2 at 39.3 weeks gestation presented to labor and delivery with nausea, vomiting, and diarrhea. The initial assessment revealed she was in early labor and was thus admitted. Objective findings demonstrate a blood pressure of 96/41, pulse of 130, temperature 98.9, hemoglobin of 8.8, and 26.7 hematocrit. Throughout labor, she maintained an elevated pulse, reaching as high as 140, with a temperature reaching 102.1. After sustained fetal tachycardia and no change in cervical dilatation, the patient was consented for a primary cesarean section. Three hours after delivery in postpartum, the patient began to have a large amount of bleeding, accompanied by numerous large clots. The Rapid Response Team (RRT) was called and assisted with stabilization of the patient. The patient continued to bleed heavily and had a blood pressure of 63/43, pulse of 141. Lab results showed a hemoglobin of 5.7 and hematocrit of 17.7. The patient was taken back to the operating room where her uterus was found to be atonic and 20 weeks in size. A total abdominal hysterectomy was performed. The patient received methergine, multiple doses of hemabate, cytotec, a total of 6 units of packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate. It was effective collaboration among multiple nursing and physician team members from postpartum, labor and delivery, RRT, intensive care unit (ICU), the operating room, hematology, and internal medicine that recognized the severity of the patient’s bleeding and systematically worked through the appropriate PPH steps and sequences to save this young patient’s life.
Conclusion:
Successful management of a postpartum hemorrhage weighs heavily on the collaboration and knowledge of multidisciplinary team members. In order to function safely and effectively within the hospital, perinatal emergency education, drills, and case study reviews must include team members outside of the women’s and newborn’s arena to optimize perinatal outcomes.
Keywords:
hysterectomy, postpartum hemorrhage, collaboration, emergency drills, rapid response team
