Case Report

摘要

Ms. Jones was a 26-year-old G3P2002 at 39 weeks' gestation as dated by first-trimester ultrasonography. She presented for an elective repeat cesarean delivery and described a history of 2 separate postpartum hemorrhages. The first occurred in 2005 after a full-term cesarean delivery secondary to a failed induction of labor. The second postpartum hemorrhage happened 8 hours after a repeat elective cesarean delivery in 2009. This was so severe that uterine artery embolization was required. Ms. Jones was taking methadone as maintenance therapy for an opiate addiction and suffered from major depressive disorder. Her history also was significant for mild intermittent asthma and tobacco use. Antenatal ultrasonography at 20 and 30 weeks revealed no evidence of abnormal placentation, with an anterior fundal placenta. Her hemoglobin level at admission was 10 g/dL; her platelet count was 152,000 B/L; and her international normalized ratio was 1.1. Her urine drug screen was positive only for opiates.