Haemorrhage during cesarean section for parturient with antiphospholipid syndrome

This case describes a 39-year-old G3P2 parturient with a history of the antiphospholipid syndrome (APS), who experienced severe hemorrhage during her cesarean section (CS) delivery of twins. At 36 weeks gestation, the patient was being treated prophylactically with Lovenox and acetylsalicyclic acid. In preparation for delivery, her medications were discontinued 24 h prior to admission. Due to breech presentation, the patient required delivery by CS. The patient received epidural anesthesia and successfully delivered two healthy babies. Following delivery, the patient became hypotensive and unresponsive and experienced uterine atony with profuse bleeding. Based on the patient′s clinical symptoms and history of APS, hemorrhage was suspected. Airway patency was immediately established using rapid sequence intubation, and the patient was placed under general anesthesia for removal of her atonic uterus. Following massive fluid resuscitation and correction of her coagulopathy, the patient stabilized and was transferred to the surgical intensive care unit. Four days later, she was discharged from the hospital without further complications