Near-Miss Maternal Mortality: Survival After Massive Postpartum Hemorrhage, Disseminated Intravascular Coagulopathy, and Multiorgan Failure

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Primary PPH, occurring within the first 24 hours after delivery, is the most common form and may rapidly progress to disseminated intravascular coagulation (DIC), multiorgan failure, and maternal near-miss events if bleeding is not promptly controlled. Patients with underlying thrombophilia are at increased risk for severe hemorrhage and coagulopathy. Case Presentation: A 35-year-old gravida 8, para 4, aborta 3 woman with Factor V Leiden thrombophilia presented for elective induction of labor at 38+4 weeks. Antenatal care was suboptimal. She initially underwent vaginal delivery but was converted to Cesarean section due to labor complications. Immediately postpartum, she developed severe PPH secondary to uterine atony, unresponsive to uterotonics and balloon tamponade. Total abdominal hysterectomy was performed, but hemorrhage persisted. Interventions: Surgical re-exploration identified bleeding from the left infundibulopelvic ligament. Hemostasis was achieved via bilateral internal iliac artery ligation and left oophorectomy. The patient received approximately 60 units of blood products, including packed RBCs, platelets, and fresh frozen plasma. She required ICU admission for disseminated intravascular coagulation (DIC), multiorgan failure, vasopressor support (norepinephrine and vasopressin), mechanical ventilation, and empirical broad-spectrum antibiotics. Outcome: The patient gradually improved, with hemodynamic stabilization, resolution of DIC, and normalization of renal and hepatic function. She was discharged in stable condition on postpartum day 11. Conclusion: This case demonstrates that hysterectomy may not always control catastrophic PPH. Early recognition of alternative bleeding sources, aggressive resuscitation, and multidisciplinary critical care are essential, especially in high-risk patients with thrombophilia, to improve survival in patients with refractory primary postpartum hemorrhage.