Postpartum Hematoma Research Articles

Efficacy and Safety of Aspirin 162 mg for Preeclampsia Prophylaxis in High-Risk Patients.

The aim of this study was to compare the safety and efficacy of aspirin 162 mg to the standard recommended dose of 81 mg for preeclampsia prevention. A retrospective cohort study of patients at risk for preeclampsia who delivered between January 2013 and December 2020 at Henry Ford Health was performed. Patients were divided into three groups: a no aspirin group, a group treated under an 81 mg aspirin preeclampsia prophylaxis protocol, and a group treated under a 162 mg protocol. Univariate and multivariable logistic regression analyses compared rates of preeclampsia and secondary outcomes between groups. Clinical side effects traditionally associated with aspirin use were also assessed. Of 3,597 patients, 2,266 (63%) were in the no aspirin group, 944 (26%) were in the 81 mg group, and 387 (11%) were in the 162 mg group. The rate of preeclampsia was significantly lower in the 162 mg group (10.1%, odds ratio, 0.68; 95% confidence interval, 0.46-0.99) compared with the 81 mg group (14.2%). The rate of preeclampsia was identical in the no aspirin and 81 mg groups. The rate for postpartum hemorrhage, postpartum hematoma, and intraventricular hemorrhage of the newborn were not significantly different between patients in the 162 and 81 mg groups. We observed a significantly lower rate of preeclampsia in high-risk patients who were treated with the 162 mg dose of aspirin for preeclampsia prophylaxis, and bleeding complications were not seen with the higher dose. Our study suggests that aspirin 162 mg may be considered for prophylaxis in patients at high risk for preeclampsia. · Aspirin 81 mg is currently standard for preeclampsia prophylaxis.. · Preeclampsia rate is significantly lower among high-risk patients taking aspirin 162 mg compared with 81 mg.. · Bleeding complications are not increased among those taking aspirin 162 mg..

Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report

Background: Parametrial hematoma is collection of blood located in the parametrial area, which is a type of hematoma that can occur in the pelvic cavity. Postpartum hematoma is a rare but life-threatening complication of childbirth. Common risk factors to developing parametrial hematomas include multiple pregnancies, traumatic deliveries, operative vaginal delivery, prolonged labour, manual removal of placenta, inadequate hemostasis at Caesarean section, pre-eclampsia, and anticoagulation therapy. We reported a rare case of parametrial hematoma post-craniotomy and curettage of a fetus with intrauterine fetal death (IUFD) in a 28-year-old pregnant woman 24 weeks into her fourth pregnancy. Case report: A pregnant woman with 24 weeks gestation age came to emergency room with complaints of abdominal pain and bloody discharge without clear fluids 9 hours prior. She was diagnosed with preterm delivery and was given tocolytic. The following day, ultrasound examination was done and fetal heart rate (FHR) was not found, suggesting an intrauterine fetal death (IUFD). Termination was carried out with oxytocin induction but due to maternal exhaustion, pain, and lack of cooperation, a craniotomy was done in operating room followed by curettage. Twenty-four hours after curettage, patient complained of an acute lower right abdominal pain and ultrasound showed a complex mass in right adnexa measuring 8 x 8 cm, suggesting a right adnexal hematoma with a differential diagnosis of a right tubo-ovarian abscess. The patient’s haemoglobin was found to decrease to 6.0 g/dl. A laparotomy was performed and a hematoma was found in the right parametrium without active bleeding. Conclusion: Parametrial hematoma is a rare disease that can occur due to trauma (in labor) or spontaneously due to abnormalities of the uterine arteries that supply blood to the uterus. The patient present in this case report had acute abdominal pain with decreased haemoglobin without signs of bleeding after an operative vaginal birth which may or may not be the cause of the parametrial hematoma due to limitations of examination on the patients. Further observation of similar cases will be required to determine the association between parametrial hematoma and operative vaginal birth.

Aspirin use during pregnancy and the risk of bleeding complications: a Swedish population-based cohort study

Aspirin is offered to pregnant women to prevent preeclampsia, a severe obstetrical complication. Large studies of nonpregnant populations have consistently shown that aspirin prophylaxis increases the risk of hemorrhagic complications. However, there have not been any population-based studies investigating this in a pregnant population. This study aimed to investigate whether aspirin use during pregnancy is associated with an increased risk of bleeding complications. We performed a register-based cohort study using the Swedish Pregnancy Register wherein we examined 313,624 women giving birth between January 2013 and July 2017. Logistic regression was used to assess the risk of antepartum, intrapartum, and postpartum hemorrhage. A propensity score and inverse probability treatment weighting was used to generate an odds ratio that corrects for differences in baseline characteristics. Aspirin use was registered in 4088 (1.3%) women during pregnancy. Compared with women who did not take aspirin, aspirin use was not associated with bleeding complications during the antepartum period (adjusted odds ratio, 1.22; 95% confidence interval, 0.97-1.54). However, aspirin users had a higher incidence of intrapartum bleeding (2.9% aspirin users vs 1.5% nonusers; adjusted odds ratio, 1.63; 95% confidence interval, 1.30-2.05), postpartum hemorrhage (10.2% vs 7.8%; adjusted odds ratio, 1.23; 95% confidence interval, 1.08-1.39), and postpartum hematoma (0.4% vs 0.1%; adjusted odds ratio, 2.21; 95% confidence interval, 1.13-4.34). The risk of a neonatal intracranial hemorrhage was also increased (0.07% vs 0.01%; adjusted odds ratio, 9.66; 95% confidence interval, 1.88-49.48). After stratifying by mode of birth, a higher incidence of bleeding among aspirin users was present for those who had a vaginal birth but not those who had a cesarean delivery. Using aspirin during pregnancy is associated with increased postpartum bleeding and postpartum hematoma. It may also be associated with neonatal intracranial hemorrhage. When offering aspirin during pregnancy, these risks need to be weighed against the potential benefits.

Clinical characteristics, treatment indications and treatment algorithm for post-partum hematomas.

Post-partum hematomas are a serious obstetrical complication. Choosing treatments for post-partum hematomas is difficult, and the application of transcatheter arterial embolization remains unclear. We aimed to clarify the clinical characteristics, identify the treatment indications and create a treatment algorithm for post-partum hematomas. Fifty-four patients with post-partum hematomas were enrolled. Hematomas were categorized according to location: upper vaginal, lower vaginal and vulvar. Blood loss, treatment methods and other clinical data were collected from the patients' medical records and analyzed retrospectively. Five, 19 and 30 patients had upper vaginal wall, lower vaginal wall and vulvar hematomas, respectively. All upper vaginal wall hematomas required transcatheter arterial embolization to control bleeding, and the average blood loss was 2473 ± 1689 mL. Most lower vaginal wall hematomas were treated surgically; however, two patients required transcatheter arterial embolization, and the average blood loss in these patients was much higher (2010 ± 1145 mL) than that in patients with lower vaginal wall hematomas (395 ± 316 mL). No patient with vulvar hematomas was treated with transcatheter arterial embolization. Two and four patients with vulvar and lower vaginal wall hematomas, respectively, were managed with observation. We created an algorithm for post-partum hematoma management. Post-partum hematoma location should guide treatment selection. Transcatheter arterial embolization should be selected for upper vaginal wall hematomas. Most lower vaginal wall hematomas are treatable with surgery, but transcatheter arterial embolization should be considered for hemostasis in difficult cases. Management with observation may also be possible for lower vaginal wall and vulvar hematomas.

Acquired Hemophilia A in the South of Tunisia: A Single Center Study

Acquired hemophilia A (AHA) is a rare and severe bleeding disorder characterized by the development of autoantibodies against factor VIII. There is no previous study published in our country for AHA. The aim of this study that to describe the clinical symptoms, diagnostic criteria and treatment strategies in patients with AHA in the south of Tunisia. We retrospectively collected all patients diagnosed with AHA in the Department of Hematology of Hedi Chaker Hospital (Tunisia) from 2000 to 2017. The diagnosis was established in the presence of clinical hemorrhagic features associated with the isolated prolongation of the activated partial thromboplastin time (APTT), not corrected after two hours by incubating patient plasma with equal volumes of normal plasma, and with factor VIII less than 50%. We collected five patients with AHA in the South of Tunisia. There were 4 females and 1 male with the median age of 32 years old. The median FVIII C was 7% and the median value of FVIII inhibitor was 11 UB. The most common clinical symptoms were post-partum hematoma in 3 patients (60%), extensive cutaneous hematoma in one patient and hemorrhagic tooth extraction in one patient. All patients were treated in first-line therapy with bypassing agent FVIIa with successful response in 80% of cases. The first-line treatment of bleeding in AHA requires a bypassing agent and the optimal therapeutic strategy to eradicate the inhibitor include immunosuppression with corticosteroids alone or corticosteroids in combination with cyclophosphamide.

Abdominal compartment syndrome resulting from postpartum hematoma of wall: a rare occurrence associated with a high risk of mortality

Objective of current study was to analyze and summarize the clinical features of postpartum abdominal hemorrhage with Abdominal Compartment Syndrome (ACS) to improve its diagnosis and treatment. A retrospective analysis of the clinical data of four cases of postpartum abdominal hemorrhage with ACS treated in our hospital from 2009 to 2014. Postpartum ACS is characterized by excessive blood loss. Symptoms mainly included oliguria, abdominal distention, shortness of breath, progressive decrease in hemoglobin and hematocrit, coagulation disorders, large volumes of ascites on computed tomography and B-type ultrasonography, and significant increases in intra-abdominal pressure. All four patients underwent surgical decompression and hemostasis, including one case of intestinal necrosis caused by ACS. Two patients fully recovered, while two patients died: one due to acute respiratory distress syndrome and one from lupus encephalopathy. Postpartum hemorrhage can lead to abdominal ACS, which is life-threatening. Physicians should attach great importance to timely diagnosis of this phenomena and early surgical decompression is key to successful treatment.

Retrospective study on the management of postpartum hematoma

Retrospective study on the management of postpartum hematoma

An Unusual Presentation and Surgical Repair of a Postpartum Pelvic Hematoma

Background: Postpartum hematomas for the most part can be treated conservatively but if there is an open wound or it is expanding rapidly or causing hemodynamic instability then surgical intervention is required. The available resources and the practitioner's surgical experience then becomes key in order to minimize morbidity in the management of complex hematomas. A 29 year old primipara, after a vacuum assisted vaginal delivery developed an expanding labial hematoma, surprisingly extending from the mons pubis to the perirectal space and inwards to the ischio rectal fossa. The patient initially had incision and drainage followed by packing of the 10cm hematoma. The pt was then transferred to Cooper. A second complex surgical intervention with complete evacuation of the hematoma and layered closure was required. Traditional surgical intervention involving complete evacuation and layered closure is still essential in the management of open postpartum pelvic hematomas.

97 Factors associated with return to work 6 months after delivery

Nowadays, there is increasing non-return to work in pregnant workers. Therefore, the objective of this study was to explore the association between general characteristics, occupational, maternal and infant factors and...

Selective Arterial Embolization as a First-Line Treatment for Postpartum Hematomas

Postpartum hematomas are a potentially serious obstetric complication for which management options are not standardized. We report successful treatment of a large postpartum hematoma using arterial embolization as primary approach. A 29-year-old woman at term gestation underwent vacuum-assisted vaginal delivery. Two hours later, marked rectal pain developed. Examination revealed a large left vaginal hematoma and no obvious bleeding sites. Computed tomography demonstrated a 10-cm supralevator hematoma and extrauterine arterial bleeding. Angiography revealed contrast extravasation from a branch of the left internal pudendal artery. Selective embolization of this branch stopped the bleeding. The patient was discharged on the third postpartum day. Eight weeks after delivery, there was no evidence of the hematoma. Arterial embolization can be used as a first-line treatment for large postpartum hematomas.

Ultrasound of the Postpartum Uterus

The ultrasound findings in the postpartum uterus will be described with a focus on differentiating normal from pathologic conditions. Imaging of the postpartum uterus will include a discussion of the normal postpartum uterus, postpartum hematomas, and retained products of conception. Clinical management and therapeutic implications based on sonographic findings will be emphasized.

Hématome rétropéritonéal géant péripartum d’un accouchement normal, « expectative attitude »

We describe a case involving spontaneous retroperitoneal hematoma complicating a normal delivery in a context of a Disseminated Intravascular Coagulation (DIVC) at the end of the pregnancy. Given the defaced symptomatology, an abdomino-pelvic scanner and an examination with a general anaesthesia made it possible to diagnose and to monitor the hematoma in intensive care. The correction of the hemostasis troubles and of the anemia, without another invasive intervention, allowed a return to home at the eighth day. The pathophysiological mechanisms underlying developpment and practicable teatments of this post-partum hematoma are discussed.

An Association of Candidate Gene Haplotypes and Bleeding Severity in von Willebrand Disease (VWD) Type 2 Pedigrees.

We analyzed the association of bleeding severity with eight candidate gene haplotypes within pedigrees of twelve index cases of VWD type 2 (six type 2M, three type 2A and three type 2B), using a covariance components model for multivariate traits (Mendel 5.5: QTL Association). In addition to the 12 index cases, these pedigrees included 58 affected and 55 unaffected relatives, as characterized by plasma Ristocetin cofactor (VWF:RCo), levels, VWF antigen (VWF:Ag) levels, ristocetin induced platelet agglutination (RIPA), VWF multimeric analysis and specific mutations of VWF. A bleeding severity score was derived from a detailed questionnaire. The severity of bleeding episodes was ranked from 0 to 5 in each of eleven bleeding categories: epistaxis, cutaneous symptomatic bleeding, bleeding from minor wounds, oral cavity bleeding, gastrointestinal bleeding, bleeding associated with tooth extraction, surgery, postpartum hematoma, muscle hematoma, hemarthrosis, and menorrhagia. Donors were genotyped using specific fluorescent-labeled oligonucleotides in a melting curve analysis (LightTyper, Roche, Inc.). VWF:RCo levels, followed closely by VWF:Ag levels, had the strongest influence on bleeding severity score. ITGA2 promoter haplotype -52T and ITGA2B haplotype 1 (Ile843) were each associated with increased bleeding severity scores (p=0.039 and p = 0.024, respectively), and the association of both remained significant when bleeding severity score was adjusted for age (p=0.012 and p = 0.010, respectively). These associations persisted even if menorrhagia, the only gender-associated bleeding category, was excluded from the analysis. This is the first report of a statistically significant association of ITGA2 haplotype -52T with risk for bleeding in vivo, a finding that is consistent with the significant attenuation of ITGA2 transcription by this promoter haplotype in in vitro studies. No statistically significant association was observed with the major haplotypes of six other candidate genes, GP1BA, ITGB3, GP6, VWF, FGB, and IL6. Increased plasma VWF:Ag levels were associated with VWF haplotype 1 (−1793G) (p=0.04), although the impact of this VWF haplotype 1 association was not of itself sufficiently strong to directly influence bleeding severity score.These results establish that genetic differences in the expression or activity of integrin receptor subunits alpha-2 and alpha-IIb can influence the bleeding phenotype of VWD type 2. Together with the results of our previous studies, these findings demonstrate that platelet receptor gene haplotypes can influence bleeding tendency not only in VWD type 1 but also in VWD type 2. Interestingly, the influence of GP6 haplotype b (Pro219) on bleeding seen in VWD type 1 was not evident in this study of VWD type 2 pedigrees. Further studies on additional VWD type 1 and type 2 pedigrees, particularly pedigrees with diverse racial and/or ethnic backgrounds, will enable us to distinguish the variety and extent of genetic differences that can influence bleeding tendency in this disease.

Postpartum hematoma and vaginal packing with a blood pressure cuff

Postpartum hematoma and vaginal packing with a blood pressure cuff

Postpartum hematoma and vaginal packing with a blood pressure cuff

Postpartum hematoma and vaginal packing with a blood pressure cuff

Postpartum extraperitoneal pelvic hematoma: imaging findings.

Severe postpartum hemorrhage can result from laceration of the genital tract during delivery. Hematomas may occur, but they often extend deep into the underlying tissues, frequently in the pelvic extraperitoneal space. Because of the relatively small amount of external hemorrhage, hematomas may be overlooked until the patient shows signs of shock [1]. Therefore, prompt diagnosis and recognition of the spread of hematomas are essential. The purpose of this essay is to illustrate the imaging findings of postpartum hematomas located in the extraperitoneal space of the pelvis.

Infection of a postpartum hematoma with Mycoplasma hominis

Infection of a postpartum hematoma with Mycoplasma hominis

Pelvic hematoma masquerading as rectal abscess: report of a case.

Postpartum pelvic hematomas, collections of blood anywhere in the pelvis between the pelvic brim and the perineum, are much more common than is evident from reports in the literature. They vary in significance from minor local vulvar and perineal hematomas that are readily visible to massive hidden retroperitoneal hematomas that may be fatal. Pain is a frequent symptom. With the vulvovaginal or vaginal hematoma, the chief complaint may be rectal pain. The proctologist should be cognizant of the entity and the similarity of its presenting symptoms to those of rectal abscess. A case of a patient who had postpartum pelvic hematoma is described. The initial symptom was severe rectal pain. The hematoma was drained by an unusual route, with a very satisfactory result.

Recurrence of a postpartum hematoma with the second vaginal delivery: Report of a case

Recurrence of a postpartum hematoma with the second vaginal delivery: Report of a case