The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

A rare case of massive postpartum hemorrhage due to inner myometrial laceration following vaginal delivery

Document Type : Case report

Authors
Sedigheh Ayati 1
leila pourali 2
Nafiseh Saghafi 2
Azadeh Shourvi 3
Atiyeh i Mohammadzadeh Vatanch 4
1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijogi.2018.12250
Abstract
Introduction: Postpartum hemorrhage is associated with highest rate of mortality and has many known etiologies. Inner myometrial laceration is one of the rare etiologies that lack of diagnosis can lead to maternal mortality. This report introduced a rare case of postpartum hemorrhage due to inner myometrial laceration.
Case presentation: The patients were a 35-year-old woman (gravida 3 and live 2) referred to the hospital due to term pregnancy and premature rupture of membrane for pregnancy termination. Normal vaginal delivery was done following labor induction. After delivery of a 3700 gr neonate, severe postpartum hemorrhage occurred which was unresponsive to medical treatment and uterotonic drugs; she was transferred to operating room and hysterectomy was performed. Then, she was transferred to ICU. On the first day of Intensive Care Unit admission, the patient was complicated by ventricular tachycardia and bradycardia, and finally cardiopulmonary arrest. CPR was done, but it was unsuccessful, and the patient was expired. Pathological assessment revealed inner myometrial laceration at the posterior uterine wall.
Conclusion: Considering inner myometrial laceration as one of the important and controllable causes of postpartum hemorrhage can lead to the diagnosis of this complication
Keywords
Myometrium
Postpartum hemorrhage
Uterine rupture
  1. Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213(1):76.e1-10.
  2. Malhotra V, Nanda S, Chauhan MB, Juneja M, Malhotra N. Inner myometrial laceration: a newer entity causing postpartum hemorrhage. J Gynecol Surg 2012; 28(6):439-40.
  3. Kaplanoglu M, Kaplanoglu D, Bulbul M, Dilbaz B. Inner myometrial laceration - an unusual presentation of antepartum and postpartum hemorrhage: case reports and review of the literature. J Matern Fetal Neonatal Med 2016; 29(16):2621-4.
  4. Gibbins KJ, Weber T, Holmgren CM, Porter TF, Varner MW, Manuck TA. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015; 213(3):382.e1-6.
  5. Conrad LB, Groome LJ, Black DR. Management of persistent postpartum hemorrhage caused by inner myometrial lacerations. Obstet Gynecol 2015; 126(2):266-9.
  6. Zwart J, Richters J, Öry F, de Vries J, Bloemenkamp KW, van Roosmalen J. Uterine rupture in the Netherlands: a nationwide population‐based cohort study. BJOG 2009; 116(8):1069-78.
  7. Hayashi M, Mori Y, Nogami KI, Takagi Y, Yaoi M, Ohkura T. A hypothesis to explain the occurrence of inner myometrial laceration causing massive postpartum hemorrhage. Acta Obstet Gynecol Scand 2000; 79(2):99-106.
  8. Sturzenegger K, Schaffer L, Zimmermann R, Haslinger C. Risk factors of uterine rupture with a special interest to uterine fundal pressure. J Perinat Med 2017; 45(3):309-13.
  9. Buhimschi CS, Buhimschi IA, Malinow AM, Kopelman JN, Weiner CP. The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour. BJOG 2002; 109(5):520-6.
  10. Abu-Rustum RS, Abu-Rustum SE, Abdo BK, Jamal MH. Inner myometrial laceration causing a massive postpartum hemorrhage: a case report. J Reprod Med 2006; 51(2):135-7.
  11. Hishikawa K, Watanabe R, Onuma K, Kusaka T, Fukuda T, Kohata Y, et al. Spontaneous uterine laceration in labor: a type of intrapartum uterine injury different from the classical uterine rupture. J Matern Fetal Neonatal Med 2018; 31(3):401-3.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 21, Issue 10
December 2018
Pages 91-94