A rare cause of postpartum hemoperitoneum: Uterine laceration secondary to sustained transabdominal uterine massage following vaginal delivery: A case report.
Chia-Yu Hu, Yao-Lung Chang
✦ AI-curated · Sources linked
Case in brief
After vaginal delivery, a patient with an unscarred uterus developed postpartum hemorrhage from uterine atony and was treated with uterotonics and transabdominal uterine massage. She later became hypotensive with abdominal tenderness. Bedside ultrasonography showed hemoperitoneum, and exploratory laparotomy identified a superficial laceration involving the myometrium and serosa. The laceration was considered likely related to sustained uterine massage. Early recognition and surgical repair were successful, avoiding irreversible injury.
What made this case unusual
The hemoperitoneum arose from a superficial uterine laceration in an unscarred uterus after vaginal delivery, with sustained transabdominal massage considered the likely cause.
Diagnostic / clinical pearl
In a patient who deteriorates after postpartum hemorrhage management, abdominal tenderness and shock should prompt consideration of hemoperitoneum; bedside ultrasonography can help identify it, with laparotomy confirming the uterine injury.