Uterine necrosis following a combination of uterine compression sutures and vascular ligation during a postpartum hemorrhage: A case report

Abstract

Introduction: The Postpartum bleeding is the first cause of maternal mortality in Morocco. It is an obstetrical emergency that requires a fast multimodal management including medical care, interventional procedure and in few cases a salvatory surgery.

Clinical case: We report a rare case of uterine necrosis following postpartum hemorrhage, refractory to medical therapy, and which was controlled by a combination of uterine hemostatic techniques and vascular ligation three days after surgery, the patient developed a fever (39°C). At day 3 of postoperative period, the patient developed a fever (39°C) associated with diffuse abdominal pain, diarrhea and non-fetid lochia. At day 5, she presented a state of sepsis. Abdominal and pelvic CT objectified gas bubbles in the uterine myometrium suggestive of necrosis. An exploratory laparotomy was performed. After adhesiolysis, exploration found a complete necrosis of the uterus DISCUSSION: There are many surgical techniques for the management of postpartum bleeding, and hysterectomy remains the reference solution in this context. However, new conservative surgical techniques that are easier to perform and are less aggressive have emerged and are becoming more commonly used.

Conclusion: We emphasize on the importance of choosing surgical techniques that lead to the preservation of uterine vascularization.

Keywords: B-Lynch; Postpartum hemorrhage; Uterine compression sutures; Uterine necrosis; Vascular ligation.

Fig. 1

Pelvic CT objectified gas bubbles in the uterine myometrium suggestive of necrosis.

Fig. 2

Bluish uterus with necrosis.