Active Arterial Hemorrhage after Successful Vaginal Delivery: A Case Report

Excessive bleeding during and after childbirth is a serious complication that can endanger the life of the mother. The present study reported a case of active arterial bleeding after normal delivery.

The patient is a 22-year-old woman, G2L1 (second pregnancy), who underwent natural childbirth due to labor pains, decreased fetal movements, and exceeding the due date. The baby girl was born naturally without any complications, with an Apgar score of 9 and a weight of 3050 grams, without dystocia or any specific abnormalities. Approximately three hours after delivery, the mother experienced dizziness and fainting while trying to get out of bed. At that time, the patient's pulse was 120 bpm, and she appeared pale. The patient's blood pressure was reported as 60/90, and there was no vaginal bleeding. The uterus was palpated in its normal position above the suprapubic area. The vagina and cervix were checked again and found to be without any abnormalities or bleeding. Due to the persistence of the patient's symptoms, an emergency abdominal and pelvic ultrasound was requested, which was performed after several hours of delay. Consultation with a urologist was requested, and it was suggested to perform a cystogram and abdominal ultrasound on the patient. The abdominal ultrasound reported a large hematoma measuring 3.14 x 7.5 x 17 cm in front of the uterus and behind the bladder. The patient was transferred to the operating room and underwent general anesthesia. The abdomen was opened through a wide incision. A large hematoma measuring 17 x 18 cm was found in the area behind the bladder and in front of the uterus, extending up to the fundus of the uterus and broad ligaments. The hematoma was drained and found to be located in the lower uterine segment, without any connection to the cervix or inside the uterus.

Active primary and secondary intra-abdominal hemorrhage is one of the surgical emergencies after delivery. The patient should undergo surgery immediately and the bleeding should be controlled.