Secondary post partum haemorrhage due to uterine wound dehiscence

Secondary post partum haemorrhage due to uterine scar dehiscence is a potentially life threatening complication of caesarean section. It is of special importance in any population with a high caesarean section rate.

Two illustrative cases are described. Both presented with life threatening haemorrhage about four weeks after delivery by lower segment caesarean section. One was successfully managed with uterine wound debridement and resuture. The other required total abdominal hysterectomy.

This cause of post partum haemorrhage must be considered in any patient who presents with heavy bleeding in the puerperium following caesarean section. These patients should always be admitted to hospital, and the uterine wound should be palpated after dilation of the cervix at examination under anaesthesia. Laparotomy and repair or hysterectomy is essential if a defect can be felt in the wound. The choice of procedure is discussed in the text.