Blog

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, responsible for roughly 94% of birth-related fatalities globally. While most cases of severe hemorrhage occur soon after birth, delayed or “secondary” postpartum hemorrhage defined as significant uterine bleeding occurring between 24 hours and 12 weeks after delivery affects approximately 0.5–2% of postpartum patients and can result in severe hemorrhagic shock. Unlike primary postpartum hemorrhage, secondary PPH frequently develops after hospital discharge, resulting in delaying recognition and treatment. Patients may lose a substantial volume of blood at home before reaching emergency care, arriving in decompensated shock.

For both early and delayed PPH, up to 90% of deaths are preventable through earlier recognition and resuscitation. Unfortunately, barriers to effective delivery of blood products can delay effective resuscitation and lead to worse patient outcomes. The following case illustrates how a LifeFlow enabled timely resuscitation and stabilization of a critically ill patient with PPH, allowing stable transfer to definitive surgical intervention.

Case Presentation

One month after delivery of a healthy baby, a 30-year-old female presented to the emergency department (ED) at OSF Center for Health Streator with sudden onset and severe vaginal bleeding. She had experienced significant hemorrhage at home prior to arrival, with an estimated blood loss of over 500 mL.

On arrival to the ED, the patient was pale, weak, and visibly frightened. She was alert and oriented but reported a feeling of impending doom. Her heart rate was in the 120s with a systolic blood pressure in the low 80s mmHg consistent with severe hypovolemic shock. Intravenous access was established via a single 18-gauge peripheral IV.

Management

Given the presentation of severe hemorrhagic shock, the care team initiated immediate blood transfusion and fluid resuscitation using LifeFlow. Through her single 18-gauge IV, the team administered four units of O-negative blood and two liters of normal saline. Pitocin was also initiated as a uterotonic agent to address the ongoing hemorrhage.

Following resuscitation, the patient’s blood pressure improved to 100/56 mmHg with a heart rate of 60. She was then transferred in stable condition to the OR for emergency surgical intervention. Despite heroic efforts at hemorrhage control, with aggressive ongoing resuscitation, the surgical team was unable to control the hemorrhage without a total hysterectomy. Fortunately, she recovered well with an overall positive outcome. Later, the patient — herself a healthcare professional — sent a thank-you letter to the care team stating that LifeFlow had saved her life.

Discussion

Secondary postpartum hemorrhage presenting to an emergency department poses unique challenges. These patients may not be anticipated outside of a Labor & Delivery unit where resuscitation resources may be more limited, and the true degree of blood loss is often underestimated because significant hemorrhage has occurred at home before arrival. In this case, the patient arrived in severe hypovolemic shock and required immediate blood transfusion through a single peripheral IV.

Conventional blood transfusion methods are often inadequate in cases such as this. Pressure bags require constant nursing attention, make it difficult to accurately measure delivered volume, and frequently cannot reverse shock quickly enough. Large automated rapid infusers can deliver higher flow rates but typically require complex setup, specialized training, and large-bore IV’s, making them impractical in many settings.

LifeFlow PLUS is a handheld rapid infuser that enables a single bedside clinician to deliver blood products at rates far exceeding those achievable with conventional methods. With LifeFlow, 500 mL of fluid or blood can be infused in approximately two minutes through a standard peripheral IV.

In this case, LifeFlow enabled timely delivery of four units of blood and two liters of normal saline through a single 18-gauge peripheral IV, improving the patient’s hemodynamics and allowing the team to stabilize her for definitive surgical care. Katilynn Rathbun, RN, described the device as “quick and easy” to set up, noting that it allowed her to administer blood quickly, make a difference in vitals, and “truly impacted the patient’s outcome.”

For patients presenting with late postpartum hemorrhage or any time-critical hemorrhagic emergency in the ED, the speed and simplicity of LifeFlow can be the difference between stabilization and deterioration. Early diagnosis and timely blood administration are essential to improving outcomes in postpartum hemorrhage.