Management of Persistent Postpartum Hemorrhage Caused by Inner Myometrial Lacerations.
BACKGROUND
Postpartum hemorrhage management must involve rapid recognition of the source of bleeding. Inner myometrial laceration is an uncommonly recognized cause; most cases are demonstrated only by evaluation of peripartum hysterectomy specimens. The exact cause of this laceration is unknown; however, it can be identified by uterine cavity exploration and managed with conservative surgery that preserves fertility.


METHODS
Postpartum hemorrhage caused by inner myometrial lacerations is presented. We explored the uterine cavity through laparotomy and uterine hysterotomy to identify and repair the source of bleeding.


CONCLUSIONS
In persistent hemorrhage that fails initial interventions, inner myometrial laceration should be considered. Uterine cavity exploration with laparotomy incision and hysterotomy to directly visualize the source are essential steps to manage postpartum hemorrhage while avoiding maternal morbidity, peripartum hysterectomy, and potential mortality.
Divisions of Gynecologic Oncology, Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, and Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Lesley B
LB
Conrad
Lynn J
LJ
Groome
Destin R
DR
Black
D000293:Adolescent; D005260:Female; D059247:Fertility Preservation; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D022125:Lacerations / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D059351:Organ Sparing Treatments; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D013536:Suture Techniques; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology / Q000601:surgery