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Secondary Postpartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Prolonged rupture of membranes, prolonged labour, multiple vaginal examinations, internal monitoring, emergency delivery, manual removal of placenta, maternal anaemia and poor socioeconomic status are risk factors for endometritis, while a history of retained placenta and placenta accreta spectrum (PAS) disorder are risk factors for retained placental tissue. Retained placental tissue, endometritis or a combination of the two, leads to subinvolution of the uterus and failure of obliteration of blood vessels underlying the placental site. Sloughing of an infected area may expose a bleeding vessel and can subsequently lead to a sudden gush of bleeding. Missed genital tract lacerations and haematomas and infected episiotomy sites may also present as secondary PPH. A uterine polyp or fibroid may get infected or prevent the uterus from involuting and lead to bleeding in the postpartum period.
Pregnancy
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
In contrast, the reason for bleeding in women with subinvolution, sometimes also known as noninvolution, of the placental bed is more obvious. The partly hyalinized uteroplacental arteries are widely distended or only partly occluded by fresh thrombi superimposed on organizing thrombi, thus allowing blood to percolate through them (Figure 3.26). Intraluminal endovascular trophoblast can be seen occasionally. Not infrequently, the curettage may have subinvoluted and involuted areas. Subinvolution of the placental bed can be a cause of bleeding following voluntary terminations of pregnancy, miscarriage and molar pregnancy in addition to following a third-trimester pregnancy.
The risk of urine bacterial colonisation in patients with a permanent catheter after caesarean section
Published in Journal of Obstetrics and Gynaecology, 2021
Jozef Zahumensky, Pavel Dolezal, Michal Braticak, Ruth Baneszova, Peter Papcun
Routine indwelling catheterisation during a caesarean section is very common in preoperative care. The aim of this procedure is the protection of the urinary bladder from iatrogenic traumatisation. To date, there have been few studies proving the benefits of this procedure (Abdel-Aleem et al. 2014). Some small randomised studies have found a lower frequency of postoperative voiding complications in women with an indwelling catheter, but the incidence of operative complications remained unchanged. (Li et al. 2011). Despite these findings, routine indwelling catheterisation remains recommended as a part of preoperative care (Page and Page 2011). The main objective of this practice is to lower the risk of postoperative subinvolution of the uterus coupled with urinary retention, which in 6.7% of cases leads to severe haemorrhages (Senanayake 2005).
Placenta Increta Presenting as Retained Placenta: A Report of 3 Cases
Published in Fetal and Pediatric Pathology, 2019
Stewart Cramer, Fadi Hatem, Debra S. Heller
Morbid adherence with both delayed postpartum hemorrhage and retained villi was observed by Ober and Grady [22]. In their 100 cases with subinvolution of the placental site (SOPS) [22], scrutiny showed 53 with retained villi, a few apposed to myometrium – indicating accreta. Retained villi apposed to myometrium were also seen in a series of 32 uteri with placental site involution, either Cesarean hysterectomies or postpartum hysterectomies for sterilization [23]. Anderson and Davis saw retained villi in a few cases, some apposed to myometrium (accreta) [23], and some with retained membranes, consistent with morbid adherence [18,23].
Diagnosis and treatment of women with radiologic findings suspicious for uterine arteriovenous malformations
Published in Journal of Obstetrics and Gynaecology, 2021
Danielle O’Rourke-Suchoff, Susana Benitez, Mikhail C.C.S. Higgins, Elizabeth A. Stier
Since the widespread availability of colour Doppler with pelvic ultrasound in the 1990s, uterine AVMs are detected by colour Doppler ultrasound (Timmerman et al. 2003). Over the past decade, it has been noted that the characteristic ultrasound findings of uterine AVM may represent other causes of hypervascularity including subinvolution of the placental bed or retained products of conception; recently the term enhanced myometrial vascularity has been proposed to better describe these ultrasound findings (Narang et al. 2015; Van den Bosch et al. 2015; Picel et al. 2016; Timor-Tritsch et al. 2016; Groszmann et al. 2018).