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Case Reports
. 2021 Sep 30;14(9):e245009.
doi: 10.1136/bcr-2021-245009.

Fertility preserving management for postpartum haemorrhage secondary to subinvolution of the placental implantation site

Ruoxing Du  1 , Rebecca Davies  1 , Prasanna Raj Supramaniam  2   3
Affiliations
Case Reports

Fertility preserving management for postpartum haemorrhage secondary to subinvolution of the placental implantation site

Ruoxing Du et al. BMJ Case Rep. .

Abstract

A 40-year-old woman presents with recurrent secondary postpartum haemorrhage (PPH) following her third normal vaginal delivery. Histology from subsequent evacuation of the uterus confirmed that she had subinvolution of the placental implantation site. Hysterectomy is the most common method of managing this condition and recurrent PPH, most often due to significant vaginal bleeding. We present a case of subinvolution of the placental implantation site with recurrent PPH managed with medical treatment alone, to offer a fertility-sparing treatment option.

Keywords: drugs: obstetrics and gynaecology; pregnancy; reproductive medicine; ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ultrasound image showing the longitudinal cross section of the endometrium taken on day 22 post delivery, following readmission with secondary postpartum haemorrhage. The left figure (A) demonstrates appearances of retained product of conception within the endometrial cavity measuring 20×8 mm. The right figure (B) shows the endometrium with colour Dopplers.
Figure 2
Figure 2
Ultrasound images showing the longitudinal cross section of the endometrium taken on. (A) Day 35 2 weeks after hysteroscopy, showing a hypoechoic mass likely representing a haematoma. (B) Day 50 on high-dose medical therapy of GnRH analogue and progesterone only pill, showing resolution of the haematoma. (C) Day 90 on progesterone only pill alone with thinned endometrium of 1.4 mm. (D) Day 118 showing thickening endometrium off medical treatment.
Figure 3
Figure 3
Ultrasound image showing the longitudinal cross section of the endometrium taken 7 months post delivery and 4 months off medical treatment. The left figure (A) demonstrates a heathy endometrium with returning endometrial thickness. The right figure (B) was produced with saline sonography to demonstrate a patent endometrium with no scarring.
See this image and copyright information in PMC

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