Uterine Necrosis Following Uterine Compression Sutures in Severe Postpartum Hemorrhage: A Case Report and Literature Review

Uterine compression sutures (UCS) are effective in treating severe atonic postpartum hemorrhage. We report a rare case of uterine necrosis following UCS combined with vascular ligation, which is a severe complication. The patient manifested persistent high fever with leukocytosis and a sub-involuted uterus after the procedure. Ultrasound combined with enhanced computed tomography (CT) is useful for the early diagnosis of uterine necrosis. Ultrasonography may show diffuse uterine enlargement, a heterogeneous myometrium, mixed mass signals, discontinuity of the myometrium, and poor blood flow signals. CT scans may reveal asymmetric density of the myometrium and loss of enhancement. Hysterectomy is the appropriate treatment. KEY CLINICAL MESSAGE: The uterine compression sutures combined with other hemostatic procedures during postpartum hemorrhage can increase the risk of uterine necrosis. Close observation is necessary to promptly recognize and manage this serious complication.