Journal of medical case reports · 2025
Partial ischemic necrosis of the uterus following artery ligation for postpartum hemorrhage after placental abruption: a case report.
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Cui Jinhui, Chen Jieying, Ouyang Liping, Fan Jianhui, Huang Zeping, Li Ping
Аннотация
BACKGROUND: Uterine necrosis is a rare condition that most commonly occurs during the postpartum period as a severe side effect of conservative interventions for postpartum hemorrhage. The primary treatment for uterine necrosis is a hysterectomy, and conservative management is rarely reported.
CASE PRESENTATION: We present the case of a 30-year-old Chinese woman, unipara, who underwent an emergency cesarean section at 35 weeks of gestation owing to a severe placental abruption. Postpartum hemorrhage occurred during the operation, and uterine artery ligation was employed to control the bleeding. The patient was diagnosed with partial uterine necrosis through contrast-enhanced ultrasound and magnetic resonance imaging 47 days postpartum. The imaging revealed a significantly thinner myometrium with enhancement following intravenous contrast (maximum thickness). The uterine mucosa was diffusely thickened and showed no perfusion. Given the mild clinical symptoms and stable hemodynamic parameters, conservative treatment was administered.
CONCLUSION: Although uterine artery ligation is an effective treatment for postpartum hemorrhage, the possible complication of uterine necrosis that may arise after this procedure requires vigilance. In cases of uterine necrosis, contrast-enhanced ultrasound exhibits diagnostic efficacy comparable to that of magnetic resonance imaging. When hemodynamic stability is maintained, conservative management emerges as a compelling therapeutic option.
CASE PRESENTATION: We present the case of a 30-year-old Chinese woman, unipara, who underwent an emergency cesarean section at 35 weeks of gestation owing to a severe placental abruption. Postpartum hemorrhage occurred during the operation, and uterine artery ligation was employed to control the bleeding. The patient was diagnosed with partial uterine necrosis through contrast-enhanced ultrasound and magnetic resonance imaging 47 days postpartum. The imaging revealed a significantly thinner myometrium with enhancement following intravenous contrast (maximum thickness). The uterine mucosa was diffusely thickened and showed no perfusion. Given the mild clinical symptoms and stable hemodynamic parameters, conservative treatment was administered.
CONCLUSION: Although uterine artery ligation is an effective treatment for postpartum hemorrhage, the possible complication of uterine necrosis that may arise after this procedure requires vigilance. In cases of uterine necrosis, contrast-enhanced ultrasound exhibits diagnostic efficacy comparable to that of magnetic resonance imaging. When hemodynamic stability is maintained, conservative management emerges as a compelling therapeutic option.