Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2392
Peer-review started: January 9, 2020
First decision: April 8, 2020
Revised: April 26, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: June 6, 2020
The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period. Here, we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life. The cause of the case we are reporting was poor incision healing. By reporting this case, we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.
A 31-year-old woman complained of acute, severe vaginal bleeding for 1 h; the patient had a history of cesarean section 3 mo prior. After receiving anti-inflammatory treatment, fluid supplementation, blood transfusion, oxytocin administration, and hemostatic treatment, the vaginal bleeding ceased, and the patient’s clinical status improved. Unfortunately, she experienced recurrent massive vaginal bleeding, and uterine contractile agents did not decrease the persistent bleeding. To save the patient’s life, she was admitted for emergency laparotomy. At exploratory laparotomy, dehiscence and necrosis of the previous cesarean section scar were noted; the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery. Ultimately, we performed a total hysterectomy.
Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later. Therefore, obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section. Such hemorrhages can be severe enough to endanger the patient's life.
Core tip: The definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period. But in this case, massive vaginal bleeding because of cesarean section incision infection, ulcer, and poor healing, appeared at 3 mo after cesarean section, and this is at odds with the traditional concept. Since the bleeding was associated with cesarean delivery operation, we think that it should also be classified as late postpartum hemorrhage, and cause enough attention in clinic, because it is serious enough to endanger the patient's life.