Diagnosis and Management of Postpartum Retroperitoneal Hematoma: A Report of 3 Cases

Abstract

Case series Patients: Female, 35-year-old • Female, 28-year-old • Female, 29-year-old Final Diagnosis: Retroperitoneal hematoma Symptoms: Anemia • arterial hypotension • signs of hypovolemic shock • sudden onset abdominal pain Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: The retroperitoneal hematoma is a very rare entity in obstetrics. A type of obstetric hematoma that extends into the retroperitoneal space, this hematoma usually occurs after laceration of the uterine artery, after uterine rupture, or by extension of a vaginal hematoma. Although the hematoma usually manifests as intense abdominal pain, sometimes the clinical signs can go unnoticed. This is the main reason it is important to report the cases in which retroperitoneal hematomas occur. In addition to clinical suspicion, experience in management can also help improve maternal morbidity and mortality from this cause. Case Reports: We present a series of 3 clinical cases in which retroperitoneal hematomas occurred after instrumental deliveries. The 3 clinical cases described took place before the COVID-19 pandemic. In the first 2 deliveries, a vacuum was used, while in the third delivery, spatulas were used. Conclusions: Our findings showed that suspicion is essential in patients with symptoms of nonspecific pain, as well as in patients with anemia that causes hemodynamic instability in the immediate postpartum period. The use of early computed tomography angiography in hemodynamically stable patients is essential to reach a diagnosis and to determine if the patient can be treated by embolization of the bleeding vessel.

Spontaneous Paravesical and Broad Ligament Hematoma after Vaginal Delivery Had Uterine Artery Embolization after Evacuating the Hematoma

“…In instances where a nonoperative method is chosen for patients with stable hemodynamic status, the administration of preventative antibiotics postpartum could be warranted to avert infection of the hematoma, even though there is a lack of widespread support for this practice in the guidelines. Prophylactic antibiotic therapy was seen being utilized in three of the case studies to prevent hematoma superinfection [7]. While there are no uniform recommendations, we suggest that the choice of antibiotics be tailored to the antimicrobial resistance patterns of each institution [7].…”

Preventing thrombotic events in a case of postpartum ovarian artery aneurysm rupture: clinical challenges and management approaches

“…Some authors preferred conservative treatment for hemodynamically stable patients with massive peripartum retroperitoneal hematoma (especially in the pelvis), while their follow-up data for complications like subsequent thromboembolic events are limited [ 6 , 12 ]. Starting coagulation prophylaxis should be delayed until ensuring a hematoma’s stability, which is time-consuming, and thus, risky for developing PE [ 12 ]. Taking such an adverse consequence into account is crucial when deciding to observe the patient rather than evacuating the hematoma and controlling the bleeding source.…”

Pólipos endometriales: diagnóstico y tratamiento

“…La etiología y fisiopatología de los pólipos endometriales no está clara, pero se ha asociado a diferentes causas. Una de ellas es la genética, ya que se han relacionado a translocaciones en los cromosomas 6 y 12, específicamente en las bandas 12q14-14 y 6p21, que afectan la proliferación celular, que dan lugar al sobrecrecimiento del endometrio y por consiguiente a los pólipos (Bullerdiek et al, 2022;Redondo et al, 2022). Incluso se puede describir la susceptibilidad genética como factor de riesgo, ya que pacientes con síndrome de Lynch y de Cowden se asocian a mayor riesgo de pólipos endometriales y de cáncer endometrial (Vieira et al, 2022).…”

“…(Salguero-Sánchez et al, 2022;Sanchez-Borrego et al, 2019) Diagnóstico El sangrado uterino anormal es la sintomatología más común de los pólipos, tanto en mujeres en edad reproductiva como en pacientes postmenopáusicas, esta puede manifestarse como sangrado intermenstrual, metrorragia postcoital, menorragia y sangrado postmenopáusico. No obstante, los pólipos pueden ser asintomáticos y ser un hallazgo incidental en pruebas de imagen (Redondo et al, 2022).…”

“…Los pólipos endometriales son un sobrecrecimiento anormal de estroma, tejido glandular y vascular que se proyectan hacia la cavidad uterina, siendo el fundus uterino su localización más común (González & Cobalea, 2022;Redondo et al, 2022). Los pólipos pueden ser únicos o múltiples, con diámetros que varían desde milímetros hasta centímetros y tienden a ser pediculados o sésiles (Salguero-Sánchez et al, 2022).…”