Mathesan Manju, Sharma Nidhi
Obstetrics and Gynaecology, Saveetha Institute of Medical and Technical Sciences, Chennai, IND.
Cureus. 2024 Jun 11;16(6):e62205. doi: 10.7759/cureus.62205. eCollection 2024 Jun.
This case report explores a rare complication of broad ligament hematoma post-vaginal delivery, emphasizing the importance of prompt intervention in cases of postpartum hemorrhage with atypical presentations. A 22-year-old primigravida, at 39 weeks with hypothyroidism, presented with intermittent abdominal pain and normal fetal movements. After a normal vaginal delivery with a right mediolateral episiotomy, she developed intense perineal pain and hypotension due to a broad ligament hematoma. The surgical intervention included the evacuation of the hematoma, laparotomy, and internal iliac artery ligation. The postoperative care involved treatment for a methicillin-resistant (MRSA) infection, and the patient received blood transfusions. The follow-up showed complete wound healing and an uneventful postnatal period, with the patient resuming normal activities after three weeks. Comparison with similar cases in the literature highlighted various etiologies and clinical presentations of broad ligament hematoma, ranging from broad ligament pregnancy to uterine perforation. Timely surgical exploration, hematoma evacuation, and arterial ligation were essential in preventing adverse maternal outcomes, underscoring the importance of multidisciplinary collaboration and vigilant postoperative monitoring. The report emphasizes the need for a high index of suspicion and prompt intervention to ensure optimal recovery and minimize complications in cases of broad ligament hematoma following vaginal delivery.
本病例报告探讨了阴道分娩后阔韧带血肿这一罕见并发症,强调了对产后出血非典型表现病例进行及时干预的重要性。一名22岁初产妇,孕39周,患有甲状腺功能减退症,出现间歇性腹痛,胎动正常。在进行右侧会阴侧切的正常阴道分娩后,她因阔韧带血肿出现剧烈会阴疼痛和低血压。手术干预包括血肿清除、剖腹术和髂内动脉结扎。术后护理包括治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染,患者接受了输血治疗。随访显示伤口完全愈合,产后过程顺利,患者在三周后恢复正常活动。与文献中类似病例的比较突出了阔韧带血肿的各种病因和临床表现,从阔韧带妊娠到子宫穿孔不等。及时的手术探查、血肿清除和动脉结扎对于预防产妇不良结局至关重要,强调了多学科协作和术后密切监测的重要性。该报告强调需要高度怀疑并及时干预,以确保阴道分娩后阔韧带血肿病例的最佳恢复并将并发症降至最低。