Year: 2025 | Month: December | Volume: 12 | Issue: 12 | Pages: 277-281
DOI: https://doi.org/10.52403/ijrr.20251232
Postpartum Hemorrhage from Uterine Atony in Resource-Limited 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: Maternal mortality remains high globally, particularly in low-resource settings. Postpartum hemorrhage is the leading cause, responsible for millions of cases and thousands of deaths annually. Indonesia’s maternal mortality, especially in rural provinces such as East Nusa Tenggara, reflects gaps in timely recognition and management of PPH at primary health centers.
Case Presentation: A 28 years old woman with a planned referral to hospital with a diagnosis of G3P2A0, 36 weeks of gestational age with severe anemia (Hb 7.00 mg/dl), refused to go to the hospital because of the local belief there. In rural parts of Indonesia local wisdom holds a more important position than health advices from professionals. This is strongly related to lower levels of education, socio-economic status, and resources constraints faced especially in the more rural parts of Indonesia. On 40 weeks of gestation, this patient came with 10 cm dilated cervix. After delivery and 3rd stage of active management was given, she suffered uterine atony which resulted in 650 cc of blood loss. For initial management of post-partum hemorrhage, the internal bimanual uterine massage was performed while two intravenous lines with Ringer Lactate with 20 IU of oxytocin as the only uterotonic available on the facility were inserted simultaneously. Only after inserting personally procured 400mcg of Misoprostol rectally did the bleeding stop and the contraction return back to normal. Tranexamic acid was not given because it was unavailable at the facility. Referral to hospital for further management was not possible due to the family refusal and the road being blocked by landslides.
Conclusion: This case report highlights the importance of proper education, health promotion, adequate resources, and also proper access to advanced health facilities to be able to provide better healthcare especially in remote areas of Indonesia and therefore can suppress both the maternal and neonatal mortality number.
Keywords: Uterine Atony, Anemia, Remote Primary Health Care, Case Report
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