Massive Obstetric Haemorrhage with Intraoperative Cell Salvage and Autotransfusion Leading to Subtotal Hysterectomy: A Case Report

Abstract

Background: Massive obstetric haemorrhage remains a leading cause of maternal morbidity and mortality worldwide, particularly among women with previous caesarean deliveries complicated by abnormal placentation. Early recognition and adherence to structured haemorrhage management protocols, including balanced blood component therapy and timely surgical intervention, are essential for optimising maternal outcomes.

Case Presentation: A report of the case of a 39-year-old gravida 3, para 3 woman with two previous caesarean deliveries who developed massive intraoperative haemorrhage of approximately 3 L during an emergency caesarean section in a private facility in Northern Nigeria. Management included uterotonic therapy, balanced blood component transfusion, and intraoperative cell salvage with autotransfusion of approximately 1.5 L of salvaged blood. Persistent haemorrhage due to placenta increta necessitated a subtotal hysterectomy to achieve definitive haemostasis. The patient recovered satisfactorily without major postoperative complications.

Conclusion: This case highlights the value of intraoperative cell salvage as an adjunct to standard blood component therapy in massive obstetric haemorrhage and underscores the importance of early escalation to definitive surgical management when conservative measures fail, particularly in resource-limited settings.