# Inner myometrial laceration complicated by severe antepartum haemorrhage: a narrative review and case report

## TL;DR

This paper reports a rare case of inner myometrial laceration causing severe bleeding during pregnancy and emphasizes the importance of early diagnosis and targeted treatment to preserve fertility.

## Contribution

The paper presents a case report and review highlighting the clinical management and surgical techniques for inner myometrial laceration.

## Key findings

- A 26-year-old patient with inner myometrial laceration was successfully treated with suturing and vascular ligation, preserving her uterus.
- Early surgical exploration and targeted repair are crucial for managing inner myometrial laceration and improving maternal outcomes.
- Hysterectomy should be considered only when conservative treatments fail.

## Abstract

Inner myometrial laceration (IML) is a rare but potentially life-threatening obstetric emergency that can cause severe antepartum or postpartum haemorrhage. The pathogenesis of this condition is not fully understood, and this condition is often associated with abnormal uterine contractions, fetal position factors, or obstetric interventions. Its clinical manifestations are nonspecific, making early diagnosis difficult and leading to potential misdiagnosis or missed diagnosis.

This report describes a 26-year-old primigravida at 38⁺¹ weeks gestation who underwent oxytocin induction for preeclampsia. During induction, she suddenly developed 1200 ml of vaginal bleeding. An emergency caesarean section revealed a 4 cm inner myometrial laceration on the posterior wall of the lower uterine segment, with the serosal layer intact. Haemostasis was successfully achieved using a “figure-of-8” suture combined with a continuous suture, supplemented with bilateral ligation of the ascending branches of the uterine arteries. The patient recovered well postoperatively, with no complications during follow-up, and her uterus was preserved.

IML is an important and occult cause of refractory antepartum or postpartum haemorrhage. Diagnosis relies on careful intraoperative exploration. Individualized suturing techniques and necessary vascular ligation are key to preserving fertility, whereas hysterectomy should be reserved as a last resort when conservative measures fail. Enhancing clinical vigilance for IML, early surgical exploration, and targeted repair is crucial for improving maternal and fetal outcomes.