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

Abstract

Background & Objective: Postpartum hemorrhage has different etiologies. One of the rare causes is inner myometrial laceration that makes the diagnosis more difficult. This report aimed to introduce a case of massive postpartum hemorrhage following an inner myometrial laceration. Case Report: A 24-year-old primigravid woman referred to an academic Hospital due to hypertension of 140/90 and diagnosis of preeclampsia. Her pregnancy was terminated at 39 th gestational week. She received two doses of 25 μg misoprostol sublingually. Subsequently, an induction was performed and normal vaginal delivery occurred. A 2800 gr infant was born. After the delivery, the patient suffered from massive postpartum hemorrhage which continued in spite of all medical treatments. With regard of unstable vital signs, laparotomy was done. By transverse uterine incision, a longitudinal inner myometrial laceration was found in the lower uterine segment, which was repaired, thus, hemorrhage was controlled. Conclusion: An inner myometrial laceration is one of the differential diagnoses of postpartum hemorrhage which should be taken into consideration. Repairing the inner myometrial laceration using laparotomy and hysterotomy would control postpartum hemorrhage and could avoid hysterectomy.

Evaluation of the Differences in Plasma Fibrinogen Levels Before and After Cesarean Section and its Association with Intra- and Postoperative Bleeding

“…Fisher's exact test showed that the relationship between fibrinogen levels at the end of surgery was significantly associated with the occurrence of PPH and sPPH (P=0.000). 1 -postpartum hemorrhage, 2 -severe postpartum hemorrhage, 3 -hemoglobin, 4 -platelet, 5 -prothrombin time, 6 -Partial Thromboplastin Time…”

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.…”

“…Since its first description, there has been 16 cases of IML reported including one that was associated with secondary PPH, 7 days after delivery 5,7–12 . In this review, only IML cases causing primary PPH are included and presented in Tables 1 and 2.…”