Management of retained placenta and uterus septum after vaginal delivery: case report

Background: Approximately 3% to 5% of obstetric patients will experience postpartum hemorrhage (PPH). Even though the most common reason for postpartum hemorrhage, as the main cause of maternal death, is uterine atony; other complications such as laceration, hematoma, inversion, rupture; retained tissue or invasive placenta; and coagulopathy may result in PPH. The main cause of retained placenta can be traced to the history of manual placenta removal, violent and numerous curettages, uterus anatomical abnormalities, placenta accreta or placenta previa, and history of cesarean section. Here, we have presented a case of retained placenta and uterus septum. Case Presentation: The patient, a 36 years old female, multigravid 11 live 3 ,death 1 and abortion 6, with a history of four normal vaginal deliveries, and history of preterm premature rupture of membrane since the 16th week of pregnancy, was admitted to Imam Reza hospital, Mashhad University of Medical Sciences due to labor pain in 29th week of pregnancy. After a vaginal delivery, she was transferred to the operating room due to a retained placenta. During the initial diagnosis, the patient’s cervix was dilated and manual placental removal was not possible. The ultrasound results showed an 80mm heterogeneous tissue in the fundus, extending to the left cornu. There was no sign of accreta. During hysterotomy, the retained placenta was removed from underneath a thick layer of Uterine Septum, using sponge forceps. Five days later, the patient returned with severe pelvic pain and signs of peritonitis. Laparotomy and hysterectomy were performed on account of uterine incision necrosis. Conclusion: The most crucial step in the treatment of retained placenta lies in the early detection of its cause. The treatment includes manual or Surgical removed of placenta which can result in bleeding, infection, and a lengthy recovery.