Transoesophageal Doppler-guided fluid Mx in massive obstetri
Massive postpartum haemorrhage is a major worldwide cause of maternal mortality. Management requires intensive fluid resuscitation and blood transfusion.

Although fluid therapy is often directed by the results of a full blood count and clotting screen, recent technological advances allow monitoring of haemodynamic function and cardiac output. Transoesophageal Doppler technology has been used during haemorrhagic shock in non-obstetric patients.

Published in the International Journal of Obsteric Anesthesia, the authors present the case of a caesarean delivery complicated by massive haemorrhage where transoesophageal Doppler monitoring with the CardioQ-ODM™ was used to guide fluid therapy and the use of vasoactive drugs.

A 36-year-old multiparous woman (height 165 cm, weight 71 kg, body mass index 26.1 kg/m2) was diagnosed with placenta praevia and possibly accreta on ultrasound scan at 35 weeks of gestation. She was scheduled for CD at 37 weeks.

After delivery of a 2660-g baby with Apgar scores of 7 and 9 at 1 and 5 min, respectively, the placenta was found to be infiltrating the urinary bladder which resulted in massive haemorrhage. The intra-arterial balloons were inflated, but did not control bleeding, which continued at approximately 200 mL/min. Rapid fluid resuscitation was started.

Haemodynamic instability with hypotension, tachycardia and impaired consciousness developed within 10 min of delivery. General anaesthesia was induced with fentanyl 300 μg, propofol 120 mg and succinylcholine 80 mg, using a rapid-sequence technique.

A transoesophageal Doppler probe inserted through the nose and connected to CardioQ-ODM™ revealed a tachycardia of 123 beats/min, cardiac index (CI) of 2.2 L/min/m2, stroke volume index (SVI) of 17.7 mL/m2, flow time (FTc) of 274 ms, peak velocity (PV) of 80.7 cm/s and mean acceleration (MA) of 7.31 m/s2.

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