A Case of Recurrent Massive Secondary Postpartum Haemorrhage following Caesarean Section Due to the Eroded Left Uterine Artery Sealed by Laparoscopic Bipolar Coagulation

Author(s): Ramkrishna Purohit, Jay Gopal Sharma, Devajani Meher

Background: Recurrent massive secondary postpartum haemorrhage (PPH) due to uterine wound dehiscence with uterine artery erosion following LSCS causes management challenges.

Case: Primiparous of 26 years had three recurrent episodes of severe PPH within 37 days after LSCS. Hysteroscopy visualized features of uterine scar dehiscence on the left angle side and excluded other causes of PPH after the 2nd episode on the 24th day and found bleeding through the wound gap. Laparoscopy after 3rd episode on 37th day revealed bleeding eroded left uterine artery. Bipolar coagulation of the left uterine artery sealed bleeding and conserved the uterus.

Conclusion: Recurrent massive PPH may occur from uterine artery erosion following LSCS scar dehiscence. Abdominal sonography, a quick hysteronscopy, and an emergency laparoscopic bipolar seal of the eroded uterine artery can serve the purpose of minimally invasive surgery in a stable patient.