Secondary Postpartum Hemorrhage Following Vaginal Birth After Cesarean (VBAC) Successfully Managed With the JADA®...

Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity, most commonly resulting from uterine atony. Management typically follows a stepwise approach using uterotonics and mechanical interventions when bleeding persists. We report the case of a 25-year-old G8P4043 (eight pregnancies, four carried to term, 0 preterm deliveries, four abortions, and three living children) woman at 38 weeks and three days' gestation who underwent a successful vaginal birth after cesarean complicated by a 45-second shoulder dystocia. Initial quantitative blood loss was 300 mL with a firm uterus. Approximately two hours postpartum, the patient developed acute uterine atony with severe pain and heavy vaginal bleeding, resulting in a cumulative blood loss of 2,055 mL. Emergency bedside ultrasound demonstrated a markedly thickened endometrial stripe with a large intrauterine clot burden and minimal vascularity. Despite uterine massage, high-dose oxytocin, misoprostol, and repeated bimanual clot evacuation, the uterus remained boggy. Second-line uterotonics were deferred due to severe hypertension and a history of significant asthma. A vacuum-induced uterine hemorrhage control device, JADA® System (Organon & Co., Jersey City, NJ, USA), was placed following manual evacuation of intrauterine clots, resulting in rapid improvement in uterine tone and bleeding. The device was removed approximately five hours later without complication. Hemoglobin declined from 11.6 g/dL to a nadir of 8.3 g/dL, and no blood transfusion or surgical intervention was required. This case highlights the importance of early recognition, bedside ultrasound assessment, and timely escalation to mechanical therapy in the management of severe primary PPH, particularly in high-risk patients with contraindications to standard second-line uterotonic agents.