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Clinical characteristics, treatment indications and treatment algorithm for post-partum hematomas
- Source :
- The journal of obstetrics and gynaecology research. 45(6)
- Publication Year :
- 2018
-
Abstract
- 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.
- Subjects :
- Adult
Vaginal Diseases
Vaginal wall
03 medical and health sciences
0302 clinical medicine
Hematoma
Gynecologic Surgical Procedures
Blood loss
Pregnancy
Medicine
Humans
In patient
cardiovascular diseases
Post partum
030219 obstetrics & reproductive medicine
business.industry
Arterial Embolization
Medical record
Obstetrics and Gynecology
pathological conditions, signs and symptoms
Puerperal Disorders
medicine.disease
Embolization, Therapeutic
Obstetric Labor Complications
body regions
surgical procedures, operative
030220 oncology & carcinogenesis
Hemostasis
cardiovascular system
Female
Vulvar Diseases
business
Algorithm
Algorithms
Subjects
Details
- ISSN :
- 14470756
- Volume :
- 45
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The journal of obstetrics and gynaecology research
- Accession number :
- edsair.doi.dedup.....e63c50700ed5013b3941cbc90bf5c361