Abstract

UTERINE NECROSIS FOLLOWING CONSERVATIVE TREATMENT FOR POSTPARTUM HAEMORRHAGE IN A CASE REPORT AND LITERATURE REVIEW

R. Sabiri*, K. Benhaddougua, K. Fadil, A. Assal, M. Jalal, A. Lamarissi, S. Bouhya

Abstract

Delivery hemorrhage remains the leading cause of death in most countries, including Morocco. Its management must be multidisciplinary and rapid. Uterine compression techniques have not been widely evaluated, but have been rapidly disseminated throughout the world due to their ease of application. Nevertheless, secondary complications have been reported in the literature, including uterine necrosis. We report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage using a combination of the B-Lynch uterine compression technique and Tsirulnikov triple vascular ligation. The patient presented with sepsis on postpartum day 2, with fever, pelvic pain and a biological inflammatory syndrome that worsened 48 hours later. Pelvic CT showed no enhancement of the myometrium after injection of PDC, suggesting myometrial necrosis. An exploratory laparotomy was performed, which revealed complete necrosis of the uterus. The surgical technique of uterine compression sutures plays a major role in the therapeutic arsenal of post-partum hemorrhage, enabling the patient's fertility to be preserved, but it also requires maximum caution and monitoring for complications, the most serious of which is uterine necrosis.

Keywords: uterine necrosis; conservative surgical treatment; patient's fertility.