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Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae.

Sengupta Dhar R, Misra R - Case Rep Obstet Gynecol (2012)

Bottom Line: All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar.Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding.Therefore, this condition may have long-term implication if missed postpartum.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi 110 016, India.

ABSTRACT
Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. Authors present here a patient with secondary postpartum haemorrhage following uterine dehiscence after caesarean delivery. Conservative management failed to control the bleeding, and she eventually needed hysterectomy. All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar. Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding. Therefore, this condition may have long-term implication if missed postpartum.

No MeSH data available.


Related in: MedlinePlus

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Mentions: On examination, there was lower abdominal tenderness with no guarding or rigidity. Abdominal scar was healthy. No abdominal mass was palpable. On pelvic examination, uterus was bulky and OS was closed. There was active bleeding. Ultrasound showed an endometrial thickness of 13 mm and an anechoic lesion of 33 × 28 × 33 mm in lower uterine segment in the left lateral wall with high velocity blood flow on doppler in the surrounding myometrium (Figure 1). Her haemoglobin was 8 gm%. Platelet count and coagulation profile were within normal limits. A pelvic angiography to exclude uterine artery aneurysm was planned. But she had sudden acute hypotension with heavy vaginal bleeding and was thus taken up for emergency laparotomy. At laparotomy, there was minimal haemoperitoneum. The uterus was enlarged to about 10–12 weeks pregnant size. On dissecting the bladder down with blunt and sharp dissection, a complete dehiscence of the entire lower segment uterine incision was identified (Figure 2). An active arterial bleed was seen at the left angle of the incision. Bladder wall was intact. The margins of the incision were unhealthy and necrosed, and therefore a decision to proceed for a total abdominal hysterectomy was taken. A swab for culture and sensitivity was taken from the margins of the uterine incision which later revealed significant growth of E. coli. She received 6 units of packed cells and 4 units of fresh frozen plasma (FFP). Her postoperative period was uneventful and she was discharged on the fifth postoperative day.


Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae.

Sengupta Dhar R, Misra R - Case Rep Obstet Gynecol (2012)

© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376497&req=5

Mentions: On examination, there was lower abdominal tenderness with no guarding or rigidity. Abdominal scar was healthy. No abdominal mass was palpable. On pelvic examination, uterus was bulky and OS was closed. There was active bleeding. Ultrasound showed an endometrial thickness of 13 mm and an anechoic lesion of 33 × 28 × 33 mm in lower uterine segment in the left lateral wall with high velocity blood flow on doppler in the surrounding myometrium (Figure 1). Her haemoglobin was 8 gm%. Platelet count and coagulation profile were within normal limits. A pelvic angiography to exclude uterine artery aneurysm was planned. But she had sudden acute hypotension with heavy vaginal bleeding and was thus taken up for emergency laparotomy. At laparotomy, there was minimal haemoperitoneum. The uterus was enlarged to about 10–12 weeks pregnant size. On dissecting the bladder down with blunt and sharp dissection, a complete dehiscence of the entire lower segment uterine incision was identified (Figure 2). An active arterial bleed was seen at the left angle of the incision. Bladder wall was intact. The margins of the incision were unhealthy and necrosed, and therefore a decision to proceed for a total abdominal hysterectomy was taken. A swab for culture and sensitivity was taken from the margins of the uterine incision which later revealed significant growth of E. coli. She received 6 units of packed cells and 4 units of fresh frozen plasma (FFP). Her postoperative period was uneventful and she was discharged on the fifth postoperative day.

Bottom Line: All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar.Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding.Therefore, this condition may have long-term implication if missed postpartum.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi 110 016, India.

ABSTRACT
Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. Authors present here a patient with secondary postpartum haemorrhage following uterine dehiscence after caesarean delivery. Conservative management failed to control the bleeding, and she eventually needed hysterectomy. All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar. Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding. Therefore, this condition may have long-term implication if missed postpartum.

No MeSH data available.


Related in: MedlinePlus