{'fraction_non_alphanumeric': 0.03044982698961938, 'fraction_numerical': 0.01730103806228374, 'mean_word_length': 4.715415019762846, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Massive non-obstetric postpartum haemorrhage

Case report A 22-year-old gravida 2 para 1 underwent an elective repeat caesarean section (performed by the author) at 38+ weeks’ gestation, at maternal request. The uterus was closed in two layers; blood loss was 400 ml and she was delivered of a female infant, apgar scores 9 and 9 at 1 and 5 minutes, birth weight 2.7kg. Twenty-four hours later she complained of feeling ‘unwell’, was pale with a tachycardia and had a distended abdomen, with peritonism; haemoglobin 6.8 gm/dl (preoperative level 12.2 gm/dl). A presumptive diagnosis of intra-abdominal bleeding from the uterine incision was made and she underwent laparotomy. There was a haemoperitoneum of approximately 2.5 l; however, inspection of uterus revealed no bleeding, but fresh bleeding was trickling down from the upper abdomen and the assistance of a general surgeon was obtained. The upper abdomen was inspected through a midline abdominal incision. No active bleeding sites were identified; however, a small subcapsular hepatic haematoma was noted and treated with diathermy. The other abdominal organs were noted to be normal. The total estimated blood loss at laparotomy was 4 l and she was transfused with blood. She was discharged well on day 10. At her postnatal visit she was well and liver function tests were normal, as was an ultrasound scan of her liver and gall bladder, performed to look for any underlying pathology.