Authors: Pragati Aggarwal, Zara Ali, Asha Sharma
Secondary postpartum hemorrhage is defined as vaginal bleeding from 24 hours after delivery to 6 weeks postpartum, rarely caused by uterine dehiscence. A 25-year-old lady, parity 2, live 2, abortion 1, with previous two cesarean section presented on postoperative day 42 with heavy bleeding per vaginum and pain abdomen since one day. The patient had history of PPH for which medical management and evacuation was done within ten days of surgery. On examination, patient was anemic, 50 cc clots removed per vaginum. Ultrasound showed RPOCs-; evacuation was done under antibiotic cover. Beta hCG and ultrasound Doppler were obtained to rule out gestational trophoblastic tumor and AV malformation respectively. Injection methotrexate was given when patient continued to have bleeding per vaginum on and off. On postoperative day 52, patient developed heavy bleeding, that did not respond to medical management. The patient was taken for emergency hysterectomy after consent was given. Per-operatively, bladder was found adherent to scar as well as scar dehiscence. Tissue around scar was found necrotic. Total abdominal hysterectomy was performed. The patient was discharged on day four in stable condition. Aim of this case study is to emphasize the-; diagnosis of uterine scar dehiscence as a cause of secondary PPH that requires a high index of suspicion in patients who are not responding to medical or surgical management;- with infection and anemia.
Secondary postpartum hemorrhage, abdominal hysterectomy, uterine dehiscence.
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