Late Postpartum Hemorrhage After Hemostatic Square Suturing Technique A Case Report

BACKGROUND: Hemostatic square suturing is a useful technique for postpartum hemorrhage, but some complications may occasionally occur. CASE: A 36-year-old pregnant woman with placenta previa and percreta at 35 weeks' gestation complicated with massive vaginal bleeding. An emergency cesarean section was performed, and placenta previa with percreta and uterine atony were noted. A hemostatic square suture was placed to compress the uterus and stopped the hemorrhage successfully. The estimated blood loss was similar to 2,200 mL. Thirty-seven days after operation, massive vaginal bleeding developed and the ultrasonography showed a 6.84 x 5.71-cm complex intrauterine mass. The patient was treated with intravenous oxytocin, rectal misoprostol, and blood transfusion. The beta-human chorionic gonadotropin levels returned to normal level on day 70 postoperatively, and ultrasonography revealed no obvious intrauterine mass. CONCLUSION: Late postpartum hemorrhage may result from the use of hemostatic square suture technique. (J Reprod Med 2009;54:454-456)