Abstract
Puerperal hematomas are rare, yet often life threatening, complications following vaginal deliveries. The etiology remains broad; however, early recognition is vital in preventing postpartum hemorrhage and maternal death. Our case illustrates treatment of a supralevator hematoma with angiographic embolization following a spontaneous vaginal delivery in a young woman. Her labor course was complicated by persistent occiput posterior presentation that failed spontaneous and manual rotation.
Highlights
The incidence of puerperal hematomas ranges from 1/300 to 1/1400 and is associated with injury to the pelvic vasculature.[1]
A review of the literature demonstrates that puerperal hematomas often arise in the absence of these risk factors, usually in the setting of a spontaneous vaginal delivery.[3]
A thorough understanding of pelvic anatomy gives rise to the classification of puerperal hematomas
Summary
The incidence of puerperal hematomas ranges from 1/300 to 1/1400 and is associated with injury to the pelvic vasculature.[1]. Our case illustrates treatment of a supralevator hematoma with angiographic embolization following a spontaneous vaginal delivery in a young woman. Her labor course was complicated by persistent occiput posterior presentation that failed spontaneous and manual rotation. The CT scan demonstrated a large supralevator intraperitoneal left pelvic sidewall hematoma measuring 11.6 x 8.6 x 9.1cm with possible compression of the pelvic side wall nerve plexus (Figure 1) It displaced the colon, cervix, and rectum to the right. We counseled the patient for a blood transfusion and bilateral uterine artery embolization given her decrease in hemoglobin in the setting of being hemodynamically stable. The patient’s hemoglobin was 11.7 g/dl and she was recovering well without complaints
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