Disseminated intravascular coagulation after massive postpartum hemorrhage due to uterine atony: a case report

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and can progress to disseminated intravascular coagulation (DIC) in severe cases. We report a case of a 36-yearold woman who developed massive PPH due to uterine atony 2.5 hours after cesarean delivery. She presented in hemorrhagic shock with overt coagulopathy, including oozing from surgical sites and hematuria. Laboratory findings confirmed DIC with unmeasurable fibrinogen and prolonged coagulation times. A massive transfusion protocol was activated, and she underwent emergency hysterectomy under general anesthesia. A total of 12 units of packed red blood cells, 12 units of fresh frozen plasma, 20 units of cryoprecipitate, and 8 units of platelets were administered. The patient stabilized hemodynamically and showed normalization of coagulation by postoperative day 1. This case highlights the importance of early recognition of obstetric DIC and a multidisciplinary response, with anesthesiologists playing a key role in hemostatic resuscitation and perioperative care.