Abstract
Postpartum haemorrhage (PPH) continues to be a significant global challenge in maternal health. Effective and timely management is essential to prevent severe morbidity and mortality. Postpartum haemorrhage is classified as primary or secondary. Management options include medical, mechanical, and surgical interventions; uterine balloon tamponade is a mechanical method used to control bleeding. We present an atypical case of secondary PPH in a 36-year-old multiparous woman with an uncomplicated antenatal course who experienced a spontaneous vaginal delivery complicated by manual removal of the placenta and primary PPH with an estimated blood loss of 3500 ml. She later presented with recurrent secondary PPH, prompting transfer to a regional tertiary care centre for further investigation. Imaging and multidisciplinary evaluation revealed uterine perforation associated with a uterine balloon tamponade. Surgical intervention via midline laparotomy was performed for uterine repair. This case highlights the importance of maintaining a high index of suspicion for uterine injury in persistent or atypical secondary PPH, particularly when mechanical interventions such as balloon tamponade are employed. Early recognition and multidisciplinary management are critical to optimising outcomes. A literature review is included to contextualise this rare but serious complication.