Sonography of subfascial hematoma after cesarean delivery

Wiener, Michael; Bowie, J D; Baker, Mark E.; Kay, Helen H.

doi:10.2214/ajr.148.5.907

Cited by 30 publications

(15 citation statements)

References 5 publications

(6 reference statements)

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“…A study performed by Shiffer and Hellman [9] revealed only 5 cases with closed peritoneum patients, all surgically treated; it states, as predisposing factors, the forced traction of the wall, the insufficient hemostasis and a 'saving effect' of sutures. Van Ham et al [10] reported 3.5% of hematomas in 2,647 CS, in agreement with Weiner et al [11] who detected a SFH by US in 32 puerperas, with a reduction of hemoglobin.…”

Section: Discussionsupporting

confidence: 76%

“…Therefore, the studies by Auh et al [8] , Wiener et al [11] , and Spring et al [12] clearly demonstrate that there are two distinct clinical anatomical entities which require a different surgical treatment. Nevertheless, the prevesical space continues through the subperitoneal fat tissue with the uterine vesical space; it is uncommon that the collections within one anatomical compartment reach the other and expand themselves with a decrease of hemoglobin [13] .…”

Section: Discussionmentioning

confidence: 95%

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Subfascial Hematomas and Hemoperitoneum after Cesarean Section: Prevalence according to Closure and Non-Closure of the Parietal Peritoneum

Malvasi¹,

Tinelli²,

Tinelli³

et al. 2008

Gynecol Obstet Invest

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Aim: To compare early hemorrhagic complications and the surgical and clinical outcome in the closure and non-closure of the parietal peritoneum in cesarean section (CS) patients. Material and Methods: We retrospectively evaluated 2,576 post-CS women subdivided and compared in two groups by open and closed parietal peritoneum (group I, n = 1,580, group II, n = 996). Results: The ultrasonographical detection of 23 blood collections (0.89%) was 14 in group I and 9 in group II, and of these we surgically treated 11 patients in group I and 8 patients in group II, with no statistical difference (p > 0.05); all group I patients showed hemoglobin point decreases and needed blood transfusions, with statistical significance (p < 0.05) linked to more severe early complications that make the post-CS outcome worse; no difference was confirmed in terms of antibiotic administration (p > 0.05). Conclusions: There was a significant increase of blood loss and transfusions in the first group. As the posterior surface of the Retzius space is open and if post-CS pathological bleeding occurs, blood can invade the peritoneal cavity causing a hemoperitoneum, with the possibility of hemorrhagic shock and a worse clinical outcome.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 95%

Subfascial Hematomas and Hemoperitoneum after Cesarean Section: Prevalence according to Closure and Non-Closure of the Parietal Peritoneum

Malvasi¹,

Tinelli²,

Tinelli³

et al. 2008

Gynecol Obstet Invest

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“…Frequently, however, hemorrhage occurs without obvious direct trauma or systemic disease. In these cases, the hematoma follows muscular straining, as in coughing and sneezing [16,25,29]; it may even develop after sports or childbirth [10,17,18,27]. The inelasticity of the artery and vein within the rectus sheath, which prevents the vessels from accommodating to sudden variations in length during contractions of Յ20 cm, has been proposed as an underlying factor (in addition to other conditions such as atherosclerosis, arteritis, aneurysm, or hypertension [10,15,16,19,22,29].…”

Section: Discussionmentioning

confidence: 99%

“…An adequate diagnosis is only made in 30-50% of cases at admission [2,9,10,12,22,23,25,29]. Several reports of misdiagnosis have been published, and various etiologic factors have been suggested, but local trauma is the main cause in most patients [6,18,20,[24][25][26][27][28][29]. Adequate diagnostic and therapeutic principles are still in debate.…”

mentioning

confidence: 99%

The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders

et al. 1999

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“…Its most common localization is infraumbilical [2,3]. It may also occur as a result of trauma, surgical intervention, and other causes, including anticoagulant therapy and blood dyscrasia [1][2][3][4][5][6][7][8][9].…”

mentioning

confidence: 99%

Rectus sheath hematoma: diagnostic classification by CT

et al. 1996

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A method of classification for hematomas of the rectus abdominis sheath (RSH) is proposed based on findings observed in CT in the 13 cases of RSH in the present study. Type I hematomas (five cases) are slight and do not require hospitalization. Type II (three cases) and type III (five cases) are moderate and severe hematomas, respectively, and do require hospitalization. The patients with type III hematomas were all undergoing anticoagulant therapy and presented with a picture of acute abdomen, and in all five cases blood transfusion was carried out. Ultrasonography and, in particular, CT permitted a correct diagnosis of RSH. RSH should be considered (anticoagulant therapy induced) in females with sudden abdominal pain to avoid unnecessary surgical intervention.

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Sonography of subfascial hematoma after cesarean delivery

Cited by 30 publications

References 5 publications

Subfascial Hematomas and Hemoperitoneum after Cesarean Section: Prevalence according to Closure and Non-Closure of the Parietal Peritoneum

Subfascial Hematomas and Hemoperitoneum after Cesarean Section: Prevalence according to Closure and Non-Closure of the Parietal Peritoneum

The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders

Rectus sheath hematoma: diagnostic classification by CT

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