A Traumatic Cesarean Delivery with Consumptive Coagulopathy

Abstract

A 39 year-old-woman, G5P1122 (L-1), is admitted to Labor & Delivery at 38 + 2/7 weeks estimated gestational age for induction of labor because of chronic hypertension and a current blood pressure (BP) of 137/94 (L-2). Other than her BP, the patient’s vital signs on admission are unremarkable and her weight and height are 76.5 kg and 160 cm, for a BMI of 30. The patient has not been taking any medications during pregnancy, has felt well, and reports frequent fetal movement. She denies headache, right upper quadrant pain, or visual changes (L-3), and her blood work on admission shows the following: WBC 10.5, Hgb 12.8, Hct 40.9, platelets 145K, BUN 7 mg/dL, and creatinine 0.7 mg/dL. Her uric acid and ALT are normal and her AST is only slightly elevated (L-4). There is a trace of protein in her urine and the urine toxicology screen is negative (L-5). The patient has delivered both of her living children vaginally and a vaginal delivery is anticipated for this pregnancy.