A 24-year-old woman, G1P0 at 41 weeks gestation, had an uneventful vaginal delivery facilitated by epidural analgesia at a medium-sized community hospital with an expanding labor and delivery service. Postpartum vaginal bleeding persisted despite administration of Pitocin and methergine. Attempts to place a Bakri uterine balloon for tamponade were unsuccessful at the bedside due to patient discomfort and agitation. Blood pressure declined despite administration of a fluid bolus, and the anesthesiologist was called for assistance with sedation and resuscitation.
At arrival of the anesthesiologist, blood pressure was 80/60 by automated cuff, with heart rate of 110. Postpartum blood loss was substantial but could not be accurately estimated. The anesthesiologist placed a second I.V., with difficulty, ordered transfusion of two units of red blood cells (RBCs), and requested equipment for an arterial line. Both the arterial line and the blood products were delayed as support personnel were called in from home....
