Chughtai Novera G, Rizvi Raheela Mohsin
Department of Urogynecology, The Aga Khan University Hospital, Karachi.
J Coll Physicians Surg Pak. 2018 Mar;28(3):S49-S50. doi: 10.29271/jcpsp.2018.03.S49.
The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a normal vaginal delivery, which led to massive postpartum hemorrhage. The diagnosis was made on Magnetic Resonance imaging (MRI) and arterial embolization was performed. This case stresses on the need for careful post-delivery monitoring for revealed postpartum hemorrhage. Vascular injury is a rare life-threatening cause of obstetric shock, and active; and timely operative intervention can prevent morbidity and mortality.
对于产科医生来说，正常分娩后产褥期血肿的管理一直具有挑战性。外阴、外阴阴道或阴道旁血肿很常见。另一方面，腹膜后血肿并不常见，但可能危及生命。术前很少能诊断出血管损伤，因为宫缩乏力或创伤性产后出血（PPH）、子宫破裂和羊水栓塞是更常见的鉴别诊断。在阴道分娩的情况下，阴部内血管和子宫血管损伤极为罕见，因此关于这一主题的文献非常稀少。我们报告了一例正常阴道分娩中阴部内动脉和子宫动脉同时破裂的罕见病例，该病例导致了大量产后出血。诊断通过磁共振成像（MRI）做出，并进行了动脉栓塞。该病例强调了产后仔细监测以发现产后出血的必要性。血管损伤是产科休克的一种罕见但危及生命的原因，积极、及时的手术干预可以预防发病和死亡。
