One of the obstetrical emergencies, puerperal vulvar hematoma threatening maternal life: A case report

Anne hayatını tehdit eden obstetrik acillerden puerperal vulvar hematom: Olgu sunumu

Abstract

Puerperal vulvar hematoma causing serious morbidity and rarely mortality is one of the life threatening obstetrical emergencies. A thirty year-old, gravida 7, parity 7, Turkish female patient was hospitalized from emergency department with the complaints of vulvar hematoma and postpartum bleeding after vaginal home delivery. Genital examination revealed a fluctuating hematoma 8x 4 cm on the left vulva. Hemoglobin level was 8.6 g/dL, hematocrit was 28%. Since moderate amount free fluid was determined on pelvic sonographic examination, the patient was operated with the suspect of uterine rupture. However, uterine rupture or retroperitoneal hematoma were not present. After the giant hematoma on vulva was evacuated, hemostasis was achieved and the operation was finished, leaving a hemovac drain. In the postoperative period, the patient was managed with intravenous antibiotic, blood transfusion, anti-inflammatory treatment and ice package on vulva, and was discharged from hospital on postoperative sixth day. We aimed to present the patient with puerperal vulvar hematoma which developed after vaginal home delivery and the management in our clinic, with a literature review.

Özet

Puerperal vulvar hematomlar ciddi morbiditeye, nadiren de mortaliteye neden olan yaşamı tehdit edebilen obstetrik acillerdendir. 30 yaşında, gravida 7, parite 7 olan hasta, evde vajinal yolla doğum sonrası postpartum kanama ve vulvar hematom şikayeti ile acil servisten kliniğimize yatırıldı. Perine muayenesinde, sol vulvada 8x4 cm’lik fluktuasyon veren hematom mevcuttu. Hemoglobini 8,6 gr/dL, hematokrit 28 % di. Ultrasonografide batın içinde orta derecede sıvı saptanması nedeniyle hasta, uterin rüptür ön tanısıyla operasyona alındı. Ancak hastada uterin rüptür ve retroperitoneal hematoma rastlanmadı. Vulvadaki dev hematom boşaltıldıktan sonra kanama kontrolü sağlandı ve hemovak dren konularak operasyona son verildi. Postoperatif takibinde; intravenöz antibiyotik, kan transfüzyonu, antiinflamatuar tedavi ve perineye buz paketi uygulanan hasta postoperatif 6. günde şifa ile taburcu edildi. Evde vajinal doğum sonrasında puerperal vulvar hematom gelişen hastayı ve kliniğimizdeki takibini literatür eşliğinde sunmayı amaçladık.