Adenomyosis a Rare Contributor to Severe Primary Post-Partum Haemorrhage

Ayokunle Moses Olumodeji, Oluwabusayo Abayomi Aborisade, Ayodeji Kayode Adefemi, Modupe Olatokunbo Adedeji, Ufuoma Oluwaseyi Olumodeji
In: International Journal of Innovative Research in Medical Science · 2021 · vol. 6(05) , pp. 356–357 · doi:10.23958/ijirms/vol06-i05/1128 · W3164697801
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This case report describes adenomyosis as a contributing factor to severe primary postpartum hemorrhage in a patient undergoing cesarean delivery of twins.

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The paper describes a case report of a 38-year-old woman with known uterine adenomyosis who achieved a successful IVF-conceived twin pregnancy and then developed severe primary postpartum hemorrhage during cesarean delivery at an estimated gestation of 35 weeks. During surgery, the uterus showed focal adenomyosis in the region of the placenta bed, and conservative hemorrhage management included uterine compression and massage, blood transfusion, intravenous carbetocin, and multiple figure-of-eight hemostatic sutures; biopsy was avoided to reduce the risk of provoking additional severe bleeding. A key caveat is that the findings are based on a single patient, and the authors note that prior infertility and prior pelvic endometriosis may indicate probable co-existing adenomyosis. This paper is centrally about adenomyosis — focal adenomyosis is presented as a rare contributor to severe primary postpartum hemorrhage in the setting of cesarean delivery.

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Abstract

Adenomyosis is a challenging clinical condition for women of reproductive age with both proven and speculated, major gynaecologic and obstetric consequences. We present the case of a woman who had adenomyosis of the uterus, a successful in-vitro fertilized (IVF) conceived twin pregnancy, and severe primary postpartum haemorrhage (PPH) during caesarean section. The 38-year-old, gravida 2, para 0+1, with a 6-year history of prior infertility, had severe primary postpartum haemorrhage at caesarean delivery of a live set of twins at estimated gestational age of 35weeks. Conservative treatment included uterine compression and massage, blood transfusion, administration of intravenous carbetocin and application of multiple figure of eight haemostatic sutures at the placenta bed. Intra-operative finding on gross inspection of the uterus was in keeping with focal adenomyosis in the region of the placenta bed. Biopsy of the involved myometrial wall was avoided due to risk of provoking further severe haemorrhage. Her prior medical record revealed pelvic endometriosis at diagnostic laparoscopy prior to conception while being evaluated for infertility. Women with prior infertility and/or endometriosis, due to very probable co-existing adenomyosis, are at high risk of life-threatening, severe post-partum haemorrhage at delivery.
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Abstract Adenomyosis is a challenging clinical condition for women of reproductive age with both proven and speculated, major gynaecologic and obstetric consequences. We present the case of a woman who had adenomyosis of the uterus, a successful in-vitro fertilized (IVF) conceived twin pregnancy, and severe primary postpartum haemorrhage (PPH) during caesarean section. The 38-year-old, gravida 2, para 0+1, with a 6-year history of prior infertility, had severe primary postpartum haemorrhage at caesarean delivery of a live set of twins at estimated gestational age of 35weeks. Conservative treatment included uterine compression and massage, blood transfusion, administration of intravenous carbetocin and application of multiple figure of eight haemostatic sutures at the placenta bed. Intra-operative finding on gross inspection of the uterus was in keeping with focal adenomyosis in the region of the placenta bed. Biopsy of the involved myometrial wall was avoided due to risk of provoking further severe haemorrhage. Her prior medical record revealed pelvic endometriosis at diagnostic laparoscopy prior to conception while being evaluated for infertility. Women with prior infertility and/or endometriosis, due to very probable co-existing adenomyosis, are at high risk of life-threatening, severe post-partum haemorrhage at delivery.

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Condition tags

endometriosisadenomyosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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