Research Information System
Kadın Sağlığı Dernekleri Federasyonu Kongresi, Antalya, Turkey, 17 - 21 April 2024, pp.166-167, (Full Text)
Among hematomas that develop during the puerperal period, those that develop in the retroperitoneal region are rare and can lead to serious life-threatening complications.Conservative orsurgical treatment can be applied to these patients. When puerperal hematoma develops, bleeding can be fatal if the patient is not cardiac and hemodynamically stable. There are many methods available for the treatment of puerperal hematomas.Among these; These include close observation, surgical drainage, finding and ligating the bleeding vessel, and compression of the vagina with gauze tamponade. Rectal packing, hysterectomy and internal iliac artery ligation are also less frequently applied treatment methods. Angiographic embolization is also among the newly defined techniques.In this case, we are talking about a 31-year-old gravida 2 parity 1 patient who developed a 120*56 mm hematoma in the retroperitoneal region after vaginal delivery.
CASE: 31 years old, gravida 2 parity 1 39 weeks pregnant, after vaginal birth performed by opening a mediolateral episiotomy in an external center; hematoma on the side wall of the vagina?, abscess? When he arrived, he was referred to us on the intraoperative day.The patient, whose vitals were stable and general condition was good, was hospitalized for follow-up and treatment. The postpartum state of the uterus was observed in the abdominal ultrasonography. Intra-abdominal free fluid was not observed. The patient underwent contrast-enhanced tomography of the lower
abdomen. In the footage taken; A hematoma measuring 120x56 mm was detected, which was thought to be in the extraperitoneal distance between the cervix and the right pelvic wall, sitting on the right lateral wall of the perirectal fascia in the posterior
and extending inferiorly along the anorectal junction and the right lateral wall of the vagina on the inner surface of the levator ani. The patient’s prenatal hemoglobin was 11.2 gr/dl, but her control hemoglobin was 7.4 gr/dl. 2 units of erythrocyte suspension (ES) were inserted. After ES, hemoglobin was detected as 9.6 g/dl. He was followed closely. No surgical intervention was planned for the patient, whose vitals were stable.The patient was called for a check-up 1 week later and was discharged on the 5th postoperative day.During the control examination,it was determined that the hematoma had regressed.
DISCUSSION: Puerperal vulvovaginal hematomas are serious obstetric complications that can be life-threatening. In order to minimize morbidity, it is necessary to make the diagnosis quickly and apply the correct treatment method.Episiotomy has been
reported at a rate of 85% to 93% in cases with puerperal hematoma. Vaginal hematomas occur more frequently with mediolateral episiotomies.Management of puerperal hematomas is diverse and controversial. Some authors recommend monitoring especially hematomas smaller than 3 cm.Conservative approach without in-
tervention in large hematomas may cause local infection, sepsis, necrosis, serious hemorrhage, and even death. According to another study, if the hematoma is large and expanding, bleeding should be prevented and hypovolemia should be corrected by surgery. In this case, a follow-up decision was made because the patient was
hemodynamically stable and the hematoma did not expand. Surgical treatment was not planned for the patient, who was followed closely, as the hematoma resolved.