International Journal of Clinical Obstetrics and Gynaecology
2021, Vol. 5, Issue 2, Part A
A Pandora’s box of postpartum hemorrhage in pregnancy
Author(s): Dr. Anurisha Asokan and Dr. Pushpalatha
Abstract: Inherited combined factor V and factor VIII deficiency (F5F8D) is autosomal recessive transmission disorder. Epistaxis, postsurgical bleeding, and menorrhagia are the most common symptoms. Other types of bleeding can occur, including hemarthrosis and muscular hematomas . Mutations in two genes- lectin mannose binding protein 1 (LMAN1) and multiple coagulation factor deficiency (MCFD2) is the cause of F5F8D . We report here a 27yr old patient born of third consanguineous marriage second gravida with previous miscarriage was admitted in early labour of a spontaneous pregnancy at 38 weeks. Following increased bleeding during dilation and curettage of previous miscarriage, patient was evaluated and diagnosed to have F5F8D. Parturient was admitted in intensive care unit, maternal and fetal monitoring was performed. Fresh frozen plasma concentrates were perfused during labor. Patient had traumatic PPH due to vaginal laceration which was repaired. Patient reported with secondary PPH two weeks later for which obstetric hysterectomy had to be resorted. Patient was monitored with daily factor V and VIII level and accordingly FFP and factor VIII was administered till wound healing. Surprisingly HPE reports of uterus showed cavernous hemangioma of endometrium. The symptomatology is not unequivocal and when it occurs during pregnancy or postpartum, it causes life-threatening cataclysmic hemorrhage. Antenatal diagnosis is difficult and requires a multidisciplinary approach. The diagnosis is histological. The cavernous hemangioma is a rare benign vascular tumor. About 50 cases of this disease were found in the literature over the last century and only 9 cases of cavernous hemangioma on the pregnant uterus were published it comes into cavernous or capillary form .