Postpartum uterine atony complicating labor in a patient with systemic lupus erythematosus: A case report

Systemic lupus erythematosus predominantly affects women of all ages, particularly targeting those of reproductive age, and can increase the risk of adverse pregnancy outcomes, including uterine atony, which is rarely documented. This case report examines uterine atony in a systemic lupus erythematosus patient and its microscopic features. A 37-year-old woman with systemic lupus erythematosus, in her fourth pregnancy, experienced vaginal bleeding, and severe hypotension after delivering at 32-33 weeks. Despite treatments including fluids, oxytocin, misoprostol, and methylergometrine, uterine contractions did not improve, leading to a supravaginal hysterectomy. Histopathology revealed hypertrophic myocytes and extensive fibrosis. This case suggests that systemic lupus erythematosus may increase the risk of uterine atony and postpartum hemorrhage due to uterine fibrosis and reduced response to uterotonics.