Peculiarities of clinical course, tactics of conduct and the outcome of pelvic hematomas in the puerperal period

详细

Objective: Supravaginal hematomas make up about 20% of total quantity of postpartum hematomas. Peculiarities of clinical picture, tactics of management and the outcome in 25 cases (8 of them after cesarean section, 15 — spontaneous delivery, 2 — forceps delivery) are analyzed.

全文:

Method: The diagnosis is based on clinical symptoms and ultrasound scanning through abdominal wall and the vagina: in 18 patients — during the first 3 days and in 7 — on the 4th-14th postpartum day.

Results: Depending on localization of the source of hemorrhage and on the direction of hematoma spreading, certain symptomocomplex is formed. Typical kinds of hematomas are distinguished: paracervical, retrocervical, retrovesical and hematoma of the broad uterine ligament. Hematoma gradually resolved and symptoms stopped in 17 women; hematoma drained through the vagina or postoperative wound in 5; after suppuration it spontaneously evacuated in 3 cases (1 - into the rectum, 1 - into the vagina, 1 — into the urinary bladder).

Conclusion: A conservative conduct of pelvic hematomas to prevent infecting and suppuration is a method of choice. Operative treatment may be used only if there is an adequate access to or suppuration of the hematoma. Surgical inspection of the abdominal cavity is of great risk of the forced hysterectomy.