Recurrent Bleeding From the Lower Segment Scar—a Late Complication of Cesarean Section

Stewart, K. S.; Evans, T. Wade

doi:10.1097/00006254-197602000-00012

Cited by 1 publication

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“…Identification of a mass, encroaching onto the bladder, led us to the diagnosis of gradual collection in the form of a utero-peritoneal pouch fistula as a result of poor healing of cesarean scar. Although surgical evacuation and possible hysterectomy for this continuous bleeding because of uncertain diagnosis have been recommended in the literature [1], we considered a conservative approach with patient's preference. The literature search in various search engines identified following case reports.…”

Section: Commentmentioning

confidence: 99%

“…Two patients underwent hysterectomy, and the pathology specimens showed different characteristics [1,2]. Vascular malformation with a thrombus in one of the veins in scar region was seen in one [1] patient, who presented with massive bleeding, requiring several units of blood transfusion. This case was published in the pre-ultra sonogram era with limited imaging technology.…”

Section: Commentmentioning

confidence: 99%

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Symptomatic Chronic Uterine Dehiscence: A Different Approach, Non-surgical Successful Closure

Baxi

Lerner

Nova³

2014

J Obstet Gynecol India

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A 37-year-old gravida 3, para 2 with suspected abruption at 36 5/7 weeks gestation had an emergency repeat lower segment cesarean section. Her obstetrical history was significant for a normal vaginal delivery followed by a lower segment cesarean section with two layer closure for a suspected placenta previa. She had multiple cardiac surgeries including patent ductus arteriosus ligation, pulmonary stenosis repair, and Konno procedure, replacement of aortic valve with prosthetic St. Jude valve, requiring several transfusions. She was on therapeutic dose of subcutaneous low-molecular-weight heparin (Enoxaparin). At the emergency cesarean section partial abruption of placenta and markedly thinned out ecchymotic scar of previous urgent cesarean section were noted. During cesarean section, scar which was found to be friable, was repaired in 2 layers of 0 Vicryl suture: the first, locking and the second, imbricating the first. She also underwent tubal ligation by Pomeroy method, and then her anticoagulation was resumed 6 h postop. Her post-operative period was uneventful.Three months following her delivery, she presented with continued periodic spotting and bleeding. She was then on warfarin and INR in low 2 0 s. There was no chorionic tissue on USG with thin endometrial stripe, normal beta HCG \ 5, TSH 2.4, and no local source of bleeding. She received progestogens in an attempt to control bleeding along with oral iron therapy. She returned 6 months postpartum for continuous bleeding, when a bulky firm lower

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Section: Commentmentioning

confidence: 99%