A hypothesis to explain the occurrence of inner myometrial laceration causing massive postpartum hemorrhage

Abstract

We have discovered another cause of postpartum hemorrhage which we have named inner myometrial laceration. These lacerations appeared to result from a strong stress on the uterine cervix caused by an abnormal rise in intrauterine pressure during labor.

Inner myometrial laceration: Case report and literature review

“…Since its first description, there has been 16 cases of IML reported including one that was associated with secondary PPH, 7 days after delivery. 5,[7][8][9][10][11][12] In this review, only IML cases causing primary PPH are included and presented in Tables 1 and 2. The incidence of IML is not known and it is thought that some of the cases could have been missed as the diagnosis can only be made by direct examination of hysterectomized uteri or during hysterotomy. There might also be minor lacerations that had been successfully managed with intrauterine tamponade.…”

“…The location of the tears (at the posterior wall and the sides of lower uterine part) suggests some forms of intrauterine pressure distributions leading to these injuries, but the exact mechanism is still far from definite. 5,8 In 58.8% of the cases, the bleeding was controlled by primary suturing through a hysterotomy wound, preserving the fertility potential. Yet seven of the 10 cases managed conservatively required additional artery ligations and/or uterine compression sutures to control the hemorrhage.…”

“…4 In the year 2000, Hayashi et al described a previously unknown trauma to the myometrium called inner myometrial laceration (IML), as one of the causes of PPH. 5 Here, we present two cases of this condition and the review of all the reported cases.…”

Massive Postpartum Hemorrhage Following an Inner Myometrial Laceration: A Case Report

“…In a study conducted in Japan by Hayashi et al, in 2000, a 27-year-old primigravid woman with no history of any specific disease referred to a hospital at 42 nd gestational week as a post term pregnancy. Pregnancy was terminated with induction of labor (oxytocin infusion).…”

Spontaneous partial uterine laceration in primigravida at 16 weeks of gestation: A case report

“…While there are many reports and data about uterine rupture, uterine laceration, in which a part of the myometrium is torn, is not well discussed. Uterine laceration is rare and almost unknown; however, it sometimes causes massive intraperitoneal bleeding and has poor prognosis [ [4] , [5] , [6] , [7] ].…”