Postpartum shock and a blood coagulation defect in which the syndrome of acute abdominal catastrophe developed is reported. Laparotomy revealed an external tear of the uterus in the region of the left isthmus and sacrouterine ligament. The tear extended through the serosa and musculature only; it did not penetrate into the uterine cavity. A retroperitoneal hematoma extended from the uterine laceration to the spleen. To control the bleeding, the uterus was amputated supra-vaginally. The possibility of such an external rupture must be considered if signs of intra-abdominal bleeding occur during or after delivery and manual exploration reveals that the uterine cavity is intact.
© 1972 The American College of Obstetricians and Gynecologists