The diagnosis and management of post-cesarean section hemorrhagic shock

The cesarean section (CS) is one of the most frequently performed surgical procedures worldwide, performed by suturing or not suturing the visceral peritoneum. In the case of not suturing the visceral peritoneum, pathological fluid collections can arise in this space and spill into the large peritoneal cavity, creating a hemoperitoneum.

In this retrospective study we evaluated 3890 repeat and first CS, performed under spinal or combined spinal-epidural anesthesia, over the last 10 years. In all the CS evaluated, we excluded those performed with open parietal peritoneum and the classical CS by closure of the visceral and parietal peritoneum.

Three important early puerperal post-CS complications with hypovolemic shock signs were detected, urgently treated by two relaparotomies and a laparoscopy.

The scientific literature reports the early benefit of not suturing the visceral peritoneum during CS, but in rare cases, early and dangerous complications occur. The post-CS hemoperitoneum must be detected immediately by transvaginal or transabdominal ultrasonography, and must be treated by needle aspiration in slight cases and by laparoscopy or laparotomy in heavy cases, with drainage and accurate hemostasis.