Vascular Subinvolution of the Placental Implantation Site as the Cause of Hysterectomy

• Published in: International journal of surgical pathology Vol. 32; no. 4; p. 787
• Main Authors: Akbarzadeh Jahromi, Mojgan, Taheri, Negar, Najib, Fatemeh Sadat, Agha Khani Nezhad, Fatemeh, Taheri, Nasim, Abiri, Fatemeh
• Format: Journal Article
• Language: English
• Published: United States 01.06.2024
• Subjects: Abortion, Spontaneous - etiology; Abortion, Spontaneous - pathology; Adult; Female; Humans; Hysterectomy - adverse effects; Placenta - blood supply; Placenta - pathology; Placenta - surgery; Postpartum Hemorrhage - diagnosis; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - pathology; Postpartum Hemorrhage - surgery; Pregnancy; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - pathology; Thrombosis - surgery; vascular subinvolution; placental; hysterectomy
• ISSN: 1940-2465
• DOI: 10.1177/10668969231188905

Vascular subinvolution of the placental bed is one of the uncommon but life-threatening forms of secondary postpartum hemorrhage. Studies on subinvolution of the implantation site are sparse and there is a scarcity of practice-based literature for this diagnosis. A 40-year-old woman with vaginal bleeding and light-headedness was admitted a few days after spontaneous abortion. Based on her unstable condition, hysterectomy was done. Pathologic gross evaluation of the uterus identified multiple large and dilated blood vessels, and microscopically, the myometrium showed thrombosis with scattered extravillous trophoblastic cells within the vessel walls. We described this rare case and explored the literature focusing on the pathophysiology and helpful ancillary studies for diagnosing this situation.