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.
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