Aim
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.
Methods
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.
Results
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.
Conclusion
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.
Objective: The treatment strategy for ovarian tumors is often uncertain when a patient wishes to have children.Especially in the case of endometriotic cysts, although pre-assisted reproductive technology ovarian cystectomy does not improve the live birth rate, surgery may be selected considering the symptom and the infertility treatment course. In such cases, it is necessary to pay attention to selecting the hemostatic method for ovarian reserve. It has been reported that hemostasis with suture / hemostatic sealant has a smaller decrease in serum anti-Müllerian hormone (AMH) level than with bipolar coagulation. We focused on this method using a hemostatic sealant.
Methods:We used Oxidized Regenerated Cellulose Powder as a hemostatic method when performing laparoscopic ovarian cystectomy. Nine patients wishing to have babies were included. The serum AMH concentration was investigated before and 3 months after surgery.
Results:The average change in AMH before and after surgery was 97.3%, showing almost no decrease.Conclusions: Using Oxidized Regenerated Cellulose Powder for hemostasis in laparoscopic ovarian cystectomy was shown to prevent a decrease in AMH level after surgery; this method could provide a sufficient protective effect on ovarian reserve.
Vaginal creation is the standard treatment for Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. Although non‐surgical method is recommended as a first‐line treatment in the American College of Obstetricians and Gynecologists guidelines for gynecological practice, it is not commonly performed in Japan. At our hospital, vaginal dilation using uterine cervical dilators (Hegar's dilator) is performed for patients with MRKH syndrome. We report four cases successfully treated with vaginal dilation. After the examination, patients were instructed to practice daily self‐dilation at home. The initiation size was No. 13 with 10.5‐mm diameter. After the vaginal cavity was dilated to a depth of 6 cm, the size of dilators was gradually increased until No. 30 with 25‐mm diameter in a tip and 28‐mm diameter in a trunk. The duration required to achieve the outcome was 5–22 months. All cases were successfully treated without any severe complication.
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