title: Recurrent secondary postpartum hemorrhages due to placental site vessel subinvolution and local uterine tissue coagulopathy.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) represents a serious problem for women and obstetricians. Because of its association with hemorrhagic shock and predisposition to disseminated coagulopathy, it is a leading cause of maternal deaths worldwide. Furthermore, the jeopardy of PPH is rising with the secondary form of PPH occurring between 24 hours and 6 weeks postpartum, when women are already discharged home. The causes of this pathology are severe inflammation (endometritis), inherited coagulation disorders, consumptive coagulopathy, and retained products of conceptions. Others are of rare occurrence, such as vessel subinvolution (VSI) of the placental implantation site, uterine artery pseudoaneurysm, or trauma.
  
  
  METHODS
  We present a rare form of recurrent secondary postpartum hemorrhage in a woman after uncomplicated cesarean delivery, with review of the literature linked to the management of this situation originating in the rare local VSI in the placental implantation site, defective decidual homeostasis, and coagulopathy confined to the uterus.
  
  
  CONCLUSIONS
  The placental site VSI is one of the rare causes of secondary PPH, and this situation is frequently underdiagnosed by clinicians. The histological confirmation of dilated "clustered"-shaped myometrial arteries partially occluded by thrombi of variable "age" together with the presence of endovascular extravillous trophoblasts confirms the diagnosis.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Martin, Kollarova 2, Martin 036 01, Slovakia. zubor@jfmed.uniba.sk.
authors.forename: Pavol
authors.initials: P
authors.lastname: Zubor
authors.forename: Karol
authors.initials: K
authors.lastname: Kajo
authors.forename: Karol
authors.initials: K
authors.lastname: Dokus
authors.forename: Stefan
authors.initials: S
authors.lastname: Krivus
authors.forename: Lubomir
authors.initials: L
authors.lastname: Straka
authors.forename: Kristina Biskupska
authors.initials: KB
authors.lastname: Bodova
authors.forename: Jan
authors.initials: J
authors.lastname: Danko
mesh_terms: D001778:Blood Coagulation Disorders / Q000150:complications*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000098:blood supply*; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D012008:Recurrence; D055988:Uterine Artery / Q000002:abnormalities*; D014599:Uterus / Q000098:blood supply*; D055815:Young Adult