Inner myometrial laceration causing a massive postpartum hemorrhage: a case report.
BACKGROUND
Postpartum hemorrhage has many well-established etiologies. It may also be secondary to an inner myometrial laceration, a less frequent and more difficult entity to diagnose.


METHODS
A 31-year-old, white woman, gravida 4, para 2012, at term underwent an uncomplicated spontaneous vaginal delivery. She gave birth to a 3,600-g female infant. An immediate massive postpartum hemorrhage ensued, unresponsive to medical therapy. No cervicovaginal lacerations or retained placental tissue was found. Uterine packing failed to control the bleeding. During laparotomy, exploration of the uterine cavity revealed a 4-cm, posterior and longitudinal inner myometrial laceration involving an actively bleeding large vessel. Repairing the laceration controlled the hemorrhage.


CONCLUSIONS
Inner myometrial lacerations must be considered in the differential diagnosis of postpartum hemorrhage when all other commonly established causes have been excluded. During laparotomy and hysterotomy, evaluation and repair of an inner myometrial laceration controls the bleeding and avoids a hysterectomy.
Department of Obstetrics and Gynecology, Nini Hospital, Tripoli, Lebanon. raburustum@yahoo.com
Reem S
RS
Abu-Rustum
Sameer E
SE
Abu-Rustum
Basma K
BK
Abdo
Michel H
MH
Jamal
D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D022125:Lacerations / Q000150:complications* / Q000175:diagnosis; D007813:Laparotomy / Q000379:methods; D009215:Myometrium / Q000293:injuries*; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome