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In a rural Minnesota town with fewer than 5000 residents, an 18-year-old woman with a term pregnancy goes into labor in a hospital that performs about 75 deliveries per year. Her pregnancy has been uncomplicated, but chorioamnionitis develops during labor and she undergoes a primary cesarean delivery for arrest of descent during the second stage of labor. Her low-risk pregnancy has become high risk — a common story for intrapartum obstetrical care in any hospital, but one that can have deadly consequences in a hospital with fewer resources, including a small staff and limited blood-bank capacity. The woman has a severe postpartum hemorrhage and loses more than 2 liters of blood. She is given the usual uterotonic medications and surgical intervention with B-Lynch suture placement, but they prove ineffective.
The lone obstetrician in the hospital is about to perform a hysterectomy when she recalls a conversation she had 2 weeks earlier with the obstetrical medical director of her hospital system about a program for team training and simulation for obstetrical emergencies that was being offered at her hospital. The director encouraged the obstetrician to reach out regarding safety concerns and left a card with her cell-phone number. Running low on options, the obstetrician contacts the director, who recommends giving the patient a transfusion from the hospital’s very limited blood supply. The director then facilitates consultation with Avera eCARE, a telehealth service that provides real-time specialty expertise to lower-resource care settings.
The teams at Avera arrange transport by helicopter to a tertiary care hospital in Sioux Falls, South Dakota, a 20-minute flight. The patient arrives 2 hours after the initial call was placed, and the telehealth specialists support both the transporting-hospital care team in stabilizing the patient for transport and the receiving care teams in intensive care and interventional radiology. The patient, who was about to have a life-altering and possibly life-threatening hysterectomy, instead undergoes a uterine artery...