title: Delayed postpartum hemorrhage in adenomyosis: a case report.
abstract: Adenomyosis of the uterus is a serious problem for women of reproductive age because of its possible consequence of infertility. We present the case of a woman who had adenomyosis of the uterus, a successful spontaneous pregnancy, and delayed and tenacious postpartum hemorrhage that did not respond to conservative treatment. The 26-year-old woman, gravida 1, para 1, suffered from fulminating vaginal bleeding and associated shock 20 days after the delivery of a 3,450-g female by Cesarean section. Conservative treatment included uterine compression and massage, blood transfusion, intravenous administration of high-dosage estrogen, oxytocin and sulprostone (prostaglandin E analogue), and gauze packing from the vagina into the uterine cavity. Despite treatment, the patient went into shock due to persistent vaginal bleeding. Emergency exploratoric assessment laparotomy was performed, followed by a stotal hysterectomy. Pathology revealed extensive adenomyosis of the uterus without other significant abnormality. The potential dangers of adenomyosis in pregnancy should not be overlooked when patients seek treatment for infertility.
authors.affiliation: Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, Taiwan, ROC.
authors.forename: P H
authors.initials: PH
authors.lastname: Wang
authors.forename: Y P
authors.initials: YP
authors.lastname: Pang
authors.forename: H T
authors.initials: HT
authors.lastname: Chao
authors.forename: C R
authors.initials: CR
authors.lastname: Lai
authors.forename: C M
authors.initials: CM
authors.lastname: Juang
authors.forename: C C
authors.initials: CC
authors.lastname: Yuan
authors.forename: H T
authors.initials: HT
authors.lastname: Ng
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D014591:Uterine Diseases / Q000150:complications*