Postpartum therapeutic anticoagulation and uterine wall haematoma: A case report

Deep vein thrombosis (DVT) during pregnancy requires timely anticoagulation to prevent complications; however, the early postpartum period is associated with an inherently elevated risk of hemorrhage, creating competing management priorities. Herein, we describe the case of a woman with dichorionic diamniotic twin pregnancy who developed progressive femoral DVT despite therapeutic unfractionated heparin (UFH) and concurrent preeclampsia and acute kidney injury. Although postoperative hemostasis after caesarean delivery initially appeared stable, therapeutic UFH was restarted early as DVT continued to progress, requiring the resumption of standard treatment. Despite seemingly adequate early hemostasis, the woman developed a massive uterine wall hematoma that required uterine artery embolization. This case illustrates the complexity of balancing thrombotic urgency against fragile postpartum hemostasis and highlights the importance of individualized anticoagulation strategies for obstetricians, surgeons, anesthesiologists, and perioperative teams caring for high-risk patients.