Hematoma formation in the broad ligament

Introduction Obstetric ligament hematoma is one of the serious complications of obstetrics, which can occur at the time of delivery or postpartum. The mass is asymptomatic and has no characteristic clinical manifestations when it is large. The tissue at the end of the incision is not tightly sutured. The edge of the incision must be sutured to more than 1 cm from the incision. It is best to knot it separately. Hemostasis is a cause of hematoma. Hematoma is induced by the accumulation of blood clots in the surrounding tissue. If the hematoma is not large, the condition is not serious, as long as the inflammation is actively controlled, the general hematoma can be absorbed. If the condition is serious, surgery should be performed.

Cause

The tissue at the end of the incision is not tightly sutured. The edge of the incision must be sutured to more than 1 cm from the incision. It is best to knot it separately. Hemostasis is a cause of hematoma. Two angle sutures of the uterus incision are critical. Immediately after the delivery of the fetus, the tissue clamp should be used to clamp the two corners of the uterus incision and the upper and lower edges to prevent the blood vessels from retracting. When the suture is crossed over the incision, it is also afraid that the blood vessel retraction is missed and a hematoma is formed. There is also a uterine incision with no cracks, and may also cause a wide ligament hematoma.

an examination

Related inspection

Obstetric B super obstetric examination

B-ultrasound can clearly see the shape of the larger organs of the fetus, the activity of the fetus in the uterus, the amount of amniotic fluid, the shape and location of the placenta, and the presence or absence of bleeding after the placenta. It is an important diagnostic tool for obstetrics. One.

Differential diagnosis

The tissue at the end of the incision is not tightly sutured. The edge of the incision must be sutured to more than 1 cm from the incision. It is best to knot it separately. Hemostasis is a cause of hematoma. Two angle sutures of the uterus incision are critical. Immediately after the delivery of the fetus, the tissue clamp should be used to clamp the two corners of the uterus incision and the upper and lower edges to prevent the blood vessels from retracting. When the suture is crossed over the incision, it is also afraid that the blood vessel retraction is missed and a hematoma is formed. There is also a uterine incision with no cracks, and may also cause a wide ligament hematoma.

B ultrasound showed hematoma.

The mass is asymptomatic and has no characteristic clinical manifestations when it is large.

(1) Vulvar hematoma: The hematoma is confined to the vulva, which is manifested as a local bulge of the vulva, and the skin or mucous membrane is purple. Often due to the laceration of the birth canal or the suture technique of the perineal lateral incision, the hemostasis is not complete, and the leaky blood vessels are not retracted. When the bleeding occurs, the blood can not flow out to form a hematoma soon after the bleeding, and the diagnosis can be found by visual observation.

(2) vaginal hematoma: hematoma range in the vaginal tissue, the appearance is difficult to find, also known as concealed hematoma, the initial maternal no obvious symptoms, the local swelling is obvious when the hematoma range is large, the treatment is more difficult, often occurs in the labor process If the hair is too long or delayed, the blood vessels of the soft canal are necrotic and ruptured due to prolonged compression. It can also occur in emergency production. The birth canal is not fully expanded, which can directly cause deep blood vessel damage and tear. It can also occur in the perineal side or side cut. The wound was stretched and the apical vessel was not sewn when suturing.

(3) vulvovaginal hematoma: the reasons are the same as the above two cases. The hematoma can be found in the vagina, the perineal body, the ischial rectal fossa, and the like.

(4) retroperitoneal hematoma: hemorrhage develops along the posterior peritoneum in the broad ligament. When the amount of bleeding is large, the fascia can be reached down to the pelvic fascia. Cervical laceration or cesarean section often occurs when the incision is delayed to the paraventricular blood vessels and the suture is improper. If the venule is ruptured, the bleeding is slow. If the artery is injured, it will develop fiercely, and the treatment will be difficult and the consequences will be serious.

The above-mentioned various types of hematoma of the birth canal are related to the damage of the birth canal, and the occurrence of hematoma is related to blood clotting dysfunction. Hematoma may form even in mild or tissue damage during labor or surgery. For example, blood diseases, especially with small blood plate reduction, insufficient synthesis of blood coagulation factors in liver disease, severe pregnancy-induced hypertension complicated with DIC. Therefore, pregnant women with the above complication should carefully stop bleeding regardless of the mode of delivery, and carefully check and observe.

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