Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding:A case report

BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life.The cause of the case we are reporting was poor incision healing.By reporting this case,we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.CASE SUMMARY A 31-year-old woman complained of acute,severe vaginal bleeding for 1 h;the patient had a history of cesarean section 3 mo prior.After receiving antiinflammatory treatment,fluid supplementation,blood transfusion,oxytocin administration,and hemostatic treatment,the vaginal bleeding ceased,and the patient’s clinical status improved.Unfortunately,she experienced recurrent massive vaginal bleeding,and uterine contractile agents did not decrease the persistent bleeding.To save the patient’s life,she was admitted for emergency laparotomy.At exploratory laparotomy,dehiscence and necrosis of the previous cesarean section scar were noted;the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery.Ultimately,we performed a total hysterectomy.CONCLUSION Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later.Therefore,obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section.Such hemorrhages can be severe enough to endanger the patient's life.

Villous Capillary Malformation and Intermediate Trophoblast Invasiveness:Histopathologic Findings From Fetomaternal Hemorrhage with Gestational Choriocarcinoma

To editor:Fetomaternal hemorrhage(FMH)refers to the fetal blood transfection into the maternal circulation,usually involving a bleeding volume exceeding 30 ml.This phenomenon can promptly trigger a sinusoidal fetal heart rate pattern,posing a significant risk of life-threatening fetal anemia and even mortality1,2 Upon suspicion of FMH,immediate intervention is essential to prevent neonatal death,often leading to the insufficient recognition of placental examination in many published reports.However,an increasing number of FMH case reports have underscored the potential subsequent risk of choriocarcinoma.