Year: 2025 | Month: December | Volume: 12 | Issue: 12 | Pages: 271-276
DOI: https://doi.org/10.52403/ijrr.20251231
Retained Placenta Causing Postpartum Hemorrhagic Shock and Severe Anemia in Rural East Nusa Tenggara, Indonesia: A Case Report
Nadya Bianca1, Edward Sugito Manurung2
1Medical Faculty, Udayana University, Denpasar, Bali, Indonesia
2Obstetrics and Gynecology Specialist, RSUD SoE, Timor Tengah Selatan District, East Nusa Tenggara, Indonesia
Corresponding Author: Nadya Bianca
ABSTRACT
Background: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, particularly in resource-limited rural settings. Retained placenta is the second most common etiology, associated with previous cesarean section, curettage, and placenta previa. Limited capacity at primary health centers challenges timely recognition and management of high-risk obstetric emergencies in Indonesia.
Case Presentation: A 42-year-old woman came to Manufui Primary Health Centre with complaints of non-stop bleeding from the birth canal after giving birth with a shaman. Estimated blood loss was around 950 ml and signs of shock were visible on arrival. Management of shock and post-partum hemorrhage were done simultaneously with fluid resuscitation, uterotonics, and finally manual removal of the placenta (MROP) was performed to help control the bleeding. MROP was done without anesthesia because of the limited resource at the facility. Tranexamic acid was not given because it was unavailable at the facility. When the bleeding was controlled and the patients were stable enough for transfer, she was referred to Soe district general hospital for further management with latest hemoglobin level of 5 gr/dl. At the hospital the patient received 3 bags of packed red cells transfusion because there’s no blood bank in the area and tubal ligation as long-term contraception.
Conclusion: Post-partum hemorrhage is the leading cause of maternal deaths worldwide, with retained placenta as one of the most common etiologies. Good management and cooperation between health care workers, the community, and various sectors are needed for the best outcomes.
Keywords: Postpartum hemorrhage, retained placenta, anemia, rural, case report
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