A rare cause of postpartum hemoperitoneum: Uterine laceration secondary to sustained transabdominal uterine massage following vaginal delivery: A case report

OBJECTIVE: To describe a case of postpartum hemoperitoneum caused by uterine laceration in an unscarred uterus, likely secondary to sustained transabdominal uterine massage. CASE REPORT: We report a case of postpartum hemorrhage resulting from a partial myometrial and serosal laceration in an unscarred uterus following vaginal delivery. Initial uterine atony was managed with uterotonics and transabdominal massage. However, the patient subsequently developed hypovolemic shock and abdominal tenderness. Bedside ultrasonography revealed hemoperitoneum, and exploratory laparotomy confirmed a superficial uterine laceration, likely related to sustained uterine massage. CONCLUSION: Uterine massage rarely causes myometrium injury and should be the first-line management approach for postpartum hemorrhage. Early diagnosis and timely intervention for myometrium laceration caused by uterine massage allowed for successful surgical repair, thereby avoiding irreversible injury.