Lifesaving Intraosseous Access in a Patient with a Massive Obstetric Hemorrhage

Abstract

A 42-year-old, gravida 1, para 0 woman was induced at a gestational age of 41 weeks because of post-term dates. The fourth stage of delivery was complicated by a massive hemorrhage. The uncontrollable persisting amount of blood loss led to hypovolemic shock and cardiopulmonary arrest. Lifesaving extra access was gained through an intraosseous needle in the proximal tibia. We therefore advocate including the use of an intraosseous needle as an additional route for intravascular volume replacement in case of peripartum hemorrhage.

Keywords

Intraosseous infusion - massive obstetric hemorrhage - peripartum - hypovolemic shock

• References

• 1 World Health Organization. WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta. Geneva: World Health Organization; 2009
• 2 Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population-based cohort study on standard (> or = 500 ml) and severe (> or = 1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2004; 115: 166-172
• 3 Jansen AJ, van Rhenen DJ, Steegers EA, Duvekot JJ. Postpartum hemorrhage and transfusion of blood and blood components. Obstet Gynecol Surv 2005; 60: 663-671
• 4 Knight M, Callaghan WM, Berg C , et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 2009; 9: 55-
• 5 Cantwell R, Clutton-Brock T, Cooper G , et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl. 01) 1-203
• 6 Chatterjee DJ, Bukunola B, Samuels TL, Induruwage L, Uncles DR. Resuscitation in massive obstetric haemorrhage using an intraosseous needle. Anaesthesia 2011; 66: 306-310
• 7 Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2007; (3) CD000494-
• 8 Nolan JP, Soar J, Zideman DA , et al; ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010; 81: 1219-1276
• 9 Knight M, Kurinczuk JJ, Spark P, Brocklehurst P ; United Kingdom Obstetric Surveillance System Steering Committee. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol 2008; 111: 97-105
• 10 RCOG Green Top Guideline No. 52. Prevention and Management of Postpartum Haemorrhage. London: Royal College of Obstetricians and Gynaecologists; 2009
• 11 Johanson R, Cox C, Grady K, Howell C. The Moet Course Manual. Managing Obstetric Emergencies and Trauma. 2nd ed. London: RCOG Press; 2007
• 12 Knight M ; UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007; 114: 1380-1387
• 13 Dutch Society of Gynaecology and Obstetrics (NVOG). Guideline Haemorrhagia Postpartum. Utrecht, The Netherlands: NVOG; 2006
• 14 ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112 (24, Suppl) IV1-IV203
• 15 Deakin CD, Nolan JP, Soar J , et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305-1352
• 16 Josefson A. A new method of treatment-intraossal injections. Acta Med Scand 1934; 81: 550-564
• 17 Luck RP, Haines C, Mull CC. Intraosseous access. J Emerg Med 2010; 39: 468-475
• 18 Sommer A, Weiss M, Deanovic D, Dave M, Neuhaus D. [Intraosseous infusion in the pediatric emergency medical service. Analysis of emergency medical missions 1990–2009]. Anaesthesist 2011; 60: 125-131
• 19 Tobias JD, Ross AK. Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use. Anesth Analg 2010; 110: 391-401
• 20 Gerritse BM, Scheffer GJ, Draaisma JM. Prehospital intraosseus access with the bone injection gun by a helicopter-transported emergency medical team. J Trauma 2009; 66: 1739-1741
• 21 Rosetti VA, Thompson BM, Miller J, Mateer JR, Aprahamian C. Intraosseous infusion: an alternative route of pediatric intravascular access. Ann Emerg Med 1985; 14: 885-888
• 22 LaSpada J, Kissoon N, Melker R, Murphy S, Miller G, Peterson R. Extravasation rates and complications of intraosseous needles during gravity and pressure infusion. Crit Care Med 1995; 23: 2023-2028
• 23 Fiser DH. Intraosseous infusion. N Engl J Med 1990; 322: 1579-1581