Dwitya|Bleeding During Inpartu with Ruptured Vaginal Varicosities: Case Report

BLEEDING DURING INPARTU WITH RUPTURED VAGINAL VARICOSITIES: CASE

REPORT

Abstract
Bleeding in pregnancy can occur before, during or after labor. To date, bleeding is the leading cause of maternal death.
Whether pervaginal or perabdominal delivery (sectio cesarea), there is always a risk of bleeding. Bleeding is said to be
physiological if the blood loss does not exceed 500 cc in vaginal delivery and no more than 1000 cc in sectio cesarea (C-
section). Antepartum bleeding can be caused by vascular abnormalities in the genital tract, including rupture of vaginal
varices (VV). This case report will discuss the incidence of bleeding during labor or inpartu with vaginal variceal rupture. A
37-year-old pregnant woman came with complaints of abdominal pain and blood mucus from the birth canal. From the
physical examination, the patient appeared in pain, compos mentis consciousness, blood pressure 150/100 mmHg, fundus
uteri height 30 cm, fetal heart rate 138x/min. Vaginal examination showed an opening of 5-6 cm, severe pain and palpable
lumps on the vulva-vagina in the 7 o'clock direction extending irregularly towards 11 o'clock. A grade 3 external
haemorrhoid was found at the anus. Complete blood examination showed leukocytes 17,800/µL, hemoglobin 11.1 g/dl,
negative proteinuria and abdominal ultrasonography (USG) examination showed the bottom of the fetus was head
presentation and the placenta did not cover the birth canal. Nifedipine 10 mg sublingual was given as antihypertensive. The
administration of tranexamic acid in this case aims as an antifibrinolytic to stop bleeding. In addition, the patient was given
two-line intravenous fluid resuscitation with lactated ringer and hydroxyethyl starch (HES) to overcome shock due to
bleeding. Ceftriaxone injection was given because infection was suspected in this patient based on the examination results
found shock due to bleeding from vaginal varices that ruptured due to straining, decreased consciousness, hypotension,
weak pulse cold acral and leukocytosis. Termination of pregnancy was done immediately to save the life of both mother
and fetus. Exploration of the vulva vaginal wall was done to identify the source of bleeding. Wound suturing of the ruptured
blood vessels was done to stop the bleeding. Blood transfusion was done to treat postpartum anemia based on the
hemoglobin level found to have dropped to 8,7 g/dl.

Keywords: bleeding, pregnancy, labor, parturition, vaginal varicosities rupture

*Correspondence : dr. Dwitya Rilianti, addres Jl. Mataram No. 38 Enggal, Bandar Lampung, HP 082185018899, e-mail
dr.witharilianti@gmail.com