• Journal of Clinical Cases
Case Report

Should Cervix Be Dilated at Non-Labor Caesarean Section? Major Postpartum Hemorrhage After Non-Laborcesarean Followed by Disseminated Intravascular Coagulation Due to Markedly Stenotic Cervical Os

Journal of Clinical Cases [2018; 1(1): 10-18]
Received: 16 May 2018, Accepted: 05 June 2018, Published: 12 June 2018

There is insufficient evidence for mechanical dilatation of cervix at non-labor cesarean section for reducing postpartum haemorrhage or infection; hence it has been recently proposed that this practice be discontinued. We present a very rare but highly significant case of major postpartum haemorrhage following non-labor cesarean when a completely stenotic cervix was found from previous diathermy loop excision for cervical intraepithelial neoplasia. Four hours after caesarean the patient collapsed with sudden major vaginal bleeding with disseminated intravascular coagulation (DIC) requiring expeditious resuscitation and return to theatre. Blood loss came under control with replacement of blood and clotting factors. Although this complication would remain very rare, in the future, there would be increasing incidence of caesareans after cervical excisional treatment for precancer and cancer. We recommend checking the cervical patency with a finger or a 10 mm dilator during non-labor caesarean. This is not just to avoid occasional cases of mild atonic haemorrhage but also to prevent very rare but catastrophic complication of DIC due to absorption of thromboplastins from trapped blood inside the uterine cavity due to intrauterine pressure created by a well retracted uterus.

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