Prostaglandin E1(Misoprostol)is useful for post cesarean section management of Redo syndrome

Background and Aim : The Redo syndrome or acute hematometra is a rare complication after terminationof pregnancy. In this situation, prompt evacuation of clotting blood led to rapid resolution of symptoms inthe patient. The goal of this presentation is the ability of prostaglandin E1 (misoprostol) to treat postcesarean section acute hematometraMethods : A 35-year-old woman referred to our hospital (III previous cesarean section) with labor painand term pregnancy. She underwent cesarean section, gave birth to a healthy baby and discharged from thehospital without any problems. After 6 days, she came back with pale and sweaty appearance, severe lowerabdominal pain and scanty vaginal bleeding after cesarean section. She treated with the diagnosis of Redosyndrome and recovered with conservative treatment.Results : Two pack cells were prescribed, because her hemoglobin was low and vital signs were unstable.After stabilization, Ultrasound showed large hematometra in uterus. She took misoprostol 200 μg intravaginal, 200 μg sublingual. After about 1.5 hours, she passed large clot and her abdominal pain graduallyrelief. 20 unit of oxytocin in1000 ml of ringer was given by intravenous drip and continuous every 8 hourfor 24 hours as uterotonic. Repeated sonographey was normal and she was discharged after 3 days.Conclusion : Take a good history about previous dilatation and curettage or various surgery procedures incervix such as cone biopsy, endometrial ablation, cryocoagulation or electrocautery. Be careful in multiprevious cesarean section patient, hematometra may occurred especially in patient she had been withsuturing of the placenta previa bed to control of bleeding. After cesarean section, make sure that the patient scervix is dilated to prevent blood clots remaining in the uterine cavity, as well as encourage the patient todo proper walking and physical activity. Antibiotics suitable for the prevention of endometritis should beconsidered, especially in prolonged membrane rupture. Clean the uterine cavity completely especially loweruterine segment for removing of chorioamnion membrane.

کلیدواژه ها:

cesarean section ، redo syndrome ، misoprostol ، hematometra