Background: Postpartum hemorrhage has many well-established etiologies. It may also be secondary to an inner myometrial laceration, a less frequent and more difficult entity to diagnose. Case: A 25-year-old gravida 2 para 1 at term underwent an uncomplicated spontaneous vaginal delievery. She gave birth to a 2.8 kg infant and an immediate massive postpartum hemorrhage ensued, which was unresponsive to medical treatment. Because of her poor general condition, an emergency hysterectomy was performed. The cut section of the uterus revealed a 4-cm vertical inner myometrial laceration, situated midline along the posterior uterine wall. Conclusions: Inner myometrial laceration must be considered in the differential diagnosis of postpartum hemorrhage when all other commonly established causes have been excluded. During laparotomy and hysterotomy, evaluation and repair of inner myometrial laceration controls the bleeding and avoids a hysterectomy. (J GYNECOL SURG 28:439)
