DOI: 10.36347/sjams.2014.v02i06.001

Pages: 1951-1953

A 26 years old woman para3 living3 presented to gynae emergency in haemorrhagic shock (secondary postpartum haemorrhage) with severe anaemia on post natal day 10 of normal vaginal delivery at home. There was history of previous one caesarian section done 5 years back followed by a full term normal vaginal delivery 3 years back and myomectomy done 1 year back. Patient was managed conservatively. She was anaemic. Rest of the routine investigations were within normal limits. Coagulation profile and βHCG were also normal. After correction of anaemia she was discharged after 5 days. Patient was admitted again after one day in v/o similar complaints and bleeding was profuse. This time Balloon tamponade was done and bleeding stopped. She continued to be anaemic. USG Doppler was done which was normal. During her stay in hospital, she had a 3rd bout of bleeding after a gap of 4 days. Patient was counselled and advised to undergo hysterectomy in view of repeated bleeding resulting in to severe anaemia. Total Abdominal Hysterectomy was done with written informed consent after arranging adequate blood. Postoperative period was uneventful. The intraoperative findings were (a) uterus 8 weeks size, smooth in outline without any rent (b) No haemoperitoneum seen (c) B/L tubes and ovaries normal. On cut section, an irregular mass of around 2×2 cm was seen arising from the posterior wall of the uterus. Histopathology showed features suggestive of syncytial endometritis/ hyperactive placental site. During follow up till date, patient is doing fine. In conclusion, hyperactive placental site is a self-limited condition which can result secondary to the retained products of conception like trophoblastic cells of mature placenta but it can be a cause of bleeding in a young female resulting in hysterectomy. Occurrence of this condition is also a rare finding.