Abstract
Delayed postpartum hemorrhage is usually caused by subinvolution of the former placental site or by partial retention of secundines. Infrequently, the cause may be a placental polyp, a ruptured varix, a submucous myoma, or exogenous estrogen therapy. Persistent bleeding requires curettage, which is not only therapeutic but frequently diagnostic. While curettage is usually effective, excessive bleeding during the procedure may require administration of oxytocin, ergot alkaloids, or uterine massage, and in severe cases invasive techniques, which include uterine packing, embolization of pelvic arteries, ligation of uterine and/or hypogastric arteries, and, as a final measure, hysterectomy, may be resorted to. In the case reported, delayed postpartum hemorrhage unresponsive to conventional curettage and uterine packing ceased promptly after intracervical and intramyometrial injection of prostaglandin F2a (PGF2a).
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