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Abstract

Introduction: Maternal “near-miss” refers to surviving severe pregnancy complications,
requiring innovative problem-solving and more resources. Postpartum hemorrhage (PPH)
is a major health risk, a leading cause of maternal death.
The Case: Mrs. R. J., 32 years, G2P1L1A0, previous uncomplicated vaginal delivery
presented at 38.4 weeks gestation with a normal antenatal course. Labour was induced with
vaginal misoprostol, resulting in the successful vaginal delivery of a healthy 3.5 kg baby
with routine preventive measures for postpartum hemorrhage. However, she experienced
acute spontaneous uterine inversion post-delivery, leading to severe PPH despite attempts
at repositioning the uterus and administration of halothane for relaxation. Compounded
by her bronchial asthma, preventing the use of carboprost, intractable bleeding persisted,
resulting in significant blood loss. With approximately 1.3 litres lost, emergency postpartum
hysterectomy became imperative to save her life. This critical intervention was executed
through a collaborative “Team Approach” involving obstetricians, anesthesiologists,
cardiologists, pediatricians, and perioperative generalists, highlighting the importance of
multidisciplinary care in managing obstetric emergencies.
Result: Following emergency postpartum hysterectomy, 4 units PRBC and 8 FFP
transfusions, the patient successfully recovered.
Conclusion: Prompt identification, timely intervention, a coordinated team approach, and
urgent management of PPH are critical for improving maternal outcomes and saving lives.
Key words: Acute Inversion Of Uterus, PPH, Maternal ‘Near Miss’, Placenta Found
Morbidly Adherent (PAS), “Multidisciplinary Care”, Obstetric Emergenciess, Coordinated
Team Approach, Unusual Complications,

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