Sheehan's syndrome is postpartum hypopituitarism due to the necrosis of the pituitary gland. Usually, it is the result of severe hypotension caused by massive hemorrhage during or after delivery. A 40-year-old woman who had been performed cesarean section delivery was complicated by hemorrhage due to uterine atony. After transfusion and hysterectomy, she is gradually recovering her general condition. On 16th day after operation, she visited emergency room in critical condition with nausea, vomiting, and general weakness and laboratory finding was hyponatremia. So, we medicated her with hydrocortisone and thyroxine. Sheehan's syndrome should be considered in the differential diagnosis of hyponatremia in the early postpartum period.
Adult ; Cesarean Section ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypopituitarism* ; Hypotension ; Hysterectomy ; Nausea ; Necrosis ; Pituitary Gland ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Thyroxine ; Uterine Inertia ; Vomiting

OBJECTIVE: The purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes. METHODS: This study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks' gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status. RESULTS: Fourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks' gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage. CONCLUSION: In women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period.
Animals ; Blood Transfusion ; Diagnosis ; Female ; Fetal Death ; Fetal Distress ; Hemorrhage ; Humans ; Mice ; Mothers ; Myometrium ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Serous Membrane ; Tears ; Tertiary Care Centers ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Rupture*

We report a case of unrecognized uterine inversion was restored spontaneously without surgical intervention. Initially, the case was diagnosed as uterine atony and not uterine inversion and was managed successfully with uterine artery embolization. However, a partial uterine inversion was detected on a subsequent scheduled pelvic examination. Fortunately, her uterus was completely restored without any surgical intervention on eighth week after delivery.
Gynecological Examination ; Postpartum Hemorrhage ; Uterine Artery Embolization ; Uterine Inertia ; Uterine Inversion* ; Uterus

Human ; Female ; Pregnancy ; Carboprost ; Uterine Inertia ; Postpartum Hemorrhage ; Oxytocin ; Maternal Mortality ; Cesarean Section ; Drug-related Side Effects And Adverse Reactions

A 29-year-old woman with mild back pain when coughing and suprapubic discomfort after voiding was admitted to Pusan National University Hospital. Two weeks earlier, she had undergone a hysterectomy and right-sided ureteroneocystostomy for uterine atony and right ureteral injury with bladder rupture. Computed tomography showed that a ureteral J stent extended from the right ovarian vein to the right cardiac chamber. The stent was retrieved via both femoral veins with a snare loop and pigtail catheter. Computed tomography showed that the urinary and vascular tracts were normal 5 months after the procedure.
Adult ; Back Pain ; Busan ; Catheters ; Cough ; Female ; Femoral Vein ; Foreign-Body Migration ; Heart ; Humans ; Hysterectomy ; Rupture ; SNARE Proteins ; Stents* ; Ureter* ; Urinary Bladder ; Uterine Inertia ; Veins

OBJECTIVE: The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH). METHODS: We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013. RESULTS: In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy. CONCLUSION: PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.
Arteries ; Cesarean Section ; Disseminated Intravascular Coagulation ; Erythrocytes ; Female ; Humans ; Hysterectomy ; Lacerations ; Massage ; Medical Records ; Multivariate Analysis ; Necrosis ; Placentation ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Retrospective Studies* ; Uterine Inertia

We report the case of a patient who suffered two events of sudden cardiac arrests separately. Sudden onset of dyspnea and cardiac arrests occurred during cesarean section in a 35-year-old woman who delivered premature baby. Instant chest compression and epinephrine 1 mg was administered. She was diagnosed to have a placenta previa totalis with bleeding preoperatively and placenta accreta was noted intraoperatively. Cesarean hysterectomy was performed due to excessive hemorrhage associated with uterine atony. Another cardiac arrests occurred during hysterectomy. After instant successful resuscitation, she recovered her heart rhythm and transferred to tertiary hospital safely. She was discharged about two months later without any major physical or neurocognitive deficits.
Cesarean Section ; Death, Sudden, Cardiac ; Dyspnea ; Emergencies ; Epinephrine ; Female ; Heart ; Heart Arrest ; Hemorrhage ; Humans ; Hysterectomy ; Placenta ; Placenta Accreta ; Placenta Previa ; Pregnancy ; Resuscitation ; Tertiary Care Centers ; Thorax ; Uterine Inertia

We describe a case of acute lumbar epidural hematoma at the L2-3 level complicated by paraplegia, which occurred after coagulation disorder because of massive bleeding intraoperatively in cesarean section. The preoperative coagulation laboratory finding was in normal range and so we tried combined spinal epidural anesthesia. Uterine atony occurred in the operation, and there was persistant bleeding during and after the operation. After the operation, she complained of paresthesia on her both legs and was diagnosed with epidural hematoma (EDH) by radiologic examination. Emergency laminectomy on lumbar spine was carried out for hematoma evacuation and decompression of the epidural space at once. In our experience, massive bleeding during surgery may potentially increase the risk of EDH postoperatively.
Anesthesia, Epidural ; Anesthesia, Spinal ; Blood Coagulation Disorders ; Cesarean Section ; Decompression ; Emergencies ; Epidural Space ; Female ; Hematoma ; Hemorrhage ; Laminectomy ; Leg ; Paraplegia ; Paresthesia ; Postpartum Hemorrhage ; Pregnancy ; Reference Values ; Spine ; Uterine Inertia

OBJECTIVE: Uterine compression sutures such as modified B-Lynch suture or multiple square-shaped sutures of uterine body are simple methods for control of postpartum hemorrhage refractory to medical treatment. We evaluated the treatment outcome and morbidity of uterine compression sutures and analyzed clinical findings of patients undergone uterine compression sutures and postpartum hysterectomy. METHODS: From January 2005 through December 2008, we retrospectively reviewed the medical records of patients undergone uterine compression sutures or postpartum hysterectomy. We analyzed success rates of preserving uterus of uterine compression sutures according to operative indications and mode of delivery and compared maternal characteristics, operative findings, morbidities and mortality with those of postpartum hysterectomy. RESULTS: The frequency of uterine compression sutures for control of massive postpartum hemorrhage was 0.24% (73/30,677). The success rates of preserving uterus were 85.1% in uterine atony, 80.9% in placenta previa, and 40.0% in placenta accreta (P=0.051). The rates of preserving uterus of uterine compression sutures after vaginal delivery and cesarean section were 50.0% and 82.6%, respectively (P=0.164). The frequencies of postoperative morbidities such as disseminated intravascular coagulation, pulmonary edema, ileus were not different between immediate hysterectomy and hysterectomy after uterine compression sutures. There was no maternal mortality. CONCLUSION: Uterine compression suture was successful method for control of postpartum hemorrhage resulting from uterine atony and placenta previa. We suggest the use of uterine compression sutures as the first-line operation for control of postpartum hemorrhage.
Cesarean Section ; Disseminated Intravascular Coagulation ; Female ; Humans ; Hysterectomy ; Ileus ; Maternal Mortality ; Medical Records ; Placenta Accreta ; Placenta Previa ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Pulmonary Edema ; Retrospective Studies ; Sutures ; Treatment Outcome ; Uterine Inertia ; Uterus

OBJECTIVE: To compare the clinical characteristics and outcome of hysterectomy and angiographic embolization in the management of obstetrical hemorrhage unresponsive to conservative management. METHODS: We retrospectively analyzed 88 patients who underwent hysterectomy and 53 patients who underwent angiographic embolization for the management of obstetrical hemorrhage from January 1999 to July 2007. We analyzed the maternal characteristics and outcomes by the review of medical records and telephone interview. Nonparametric test was performed for comparison of both groups. RESULTS: Angiographic embolization for the management of obstetrical hemorrhage is on the increase year by year, consisting of about three quarters of total cases in the last year. The most common indication of hysterectomy was abnormal placentation (68.2%) followed by uterine atony (25.0%). For the embolization, the most common indication was uterine atony (54.7%) followed by abnormal placentation (17%). The median pre-operative hemoglobin was significantly lower in embolization group than hysterectomy group [8.3 (3.8~12.7 g/dL) vs. 10.8 (2.4~13.7 g/dL), P<0.001]. There was no difference in the total transfusion amount of packed RBC between the two groups. The median hospital stay was shorter in embolization group [8 (5~57 days) vs. 6 (3~14 days), P<0.001]. Overall success rate of embolization was 89% and procedure-related acute complications were not occurred. Of the total population, there was one maternal death in the hysterectomy group. We found that most women who underwent the embolization resume normal menstruation. CONCLUSION: Angiographic embolization for the management of obstetrical hemorrhage is more commonly performed in recent years. Angiographic embolization was associated with shorter hospital stay, reasonable success rate, and minimal complication rate.
Female ; Hemoglobins ; Hemorrhage ; Humans ; Hysterectomy ; Interviews as Topic ; Length of Stay ; Maternal Death ; Medical Records ; Placentation ; Postpartum Hemorrhage ; Retrospective Studies ; Uterine Inertia