Dheeraj Yella
SRMC,Chennai
Title: Spontaneous broad ligament haematoma following normal vaginal delivery
Biography
Biography: Dheeraj Yella
Abstract
CASE DESCRIPTION-
Broad ligament haematoma is a rare complication following a normal vaginal delivery.
We report one such case of a woman who developed this complication within 3 hrs of normal vaginal delivery.
She is G2P1L1, 38 wks GA, in active labour.
Pt was allowed for spontaneous progression of labour, following which she delivered vaginally. Within 3 hrs patient looked clinically very pale with vitals being deranged and complains of inability to void urine, severe perineal pain.
On basis of clinical examination and transabdominal ultrasound features a diagnosis of right sided broad ligament haematoma was made.
Based on patients haemodynamic instability surgical management in the form of obstetric hysterectomy was done.
DISCUSSION
Broad ligament haematoma is a relatively uncommon complication that can occur following a spontaneous vaginal delivery.
It can be silent and not cause any obvious vaginal bleeding. Clinical symptoms are vague with persistent perineal pain, urge to defecate, unable to void within first few hours of delivery.
Imaging modalities like transabdominal ultrasound and MRI can help in confirming the diagnosis. It has been suggested that MRI depicts postpartum hemorrhage even in deep extraperitoneal regions where the hematoma is clinically non-apparent, and in addition it can delineate the extent of the hematoma.
Broad ligament haematoma can be managed both conservatively and surgically depending on patients haemodynamic status, size and rate of haematoma expansion.
Small non spreading ones can be managed conservatively however larger ones might need internal illiac artery ligation, UAE or even hysterectomy.
Our patient was haemodynamically unstable after confirmed diagnosis and given the circumstances that the haematoma was expanding we decided on the surgical management i.e subtotal hysterectomy.