Birth canal hematoma

Introduction Hepatoma of the birth canal refers to hematoma in the soft birth canal, ie, the lower uterus, the cervix, the vagina, and the perineum, within hours of delivery. There is no obvious symptom in the first stage of maternal, the range of hematoma is obvious when the local pain is obvious, and the treatment is also difficult. It often occurs in the long process of labor or delayed production. The blood vessels of the soft birth canal are necrotic and ruptured due to prolonged compression. Rapid production, the birth canal is not fully expanded, can directly cause deep blood vessel damage and tear, can also occur in the perineal side cut or side cut wound extension, the top end of the blood vessels are not sewn. Hematoma is also associated with blood clotting dysfunction. Hematoma may form even in mild tissue damage during labor or surgery. For example, blood diseases, especially with small blood platelets, insufficient blood coagulation factor synthesis during liver disease, severe pregnancy-induced hypertension complicated with DIC Waiting for the situation.

Cause

1, combined with pregnancy-induced hypertension syndrome: patients with pregnancy-induced hypertension, due to increased peripheral vascular resistance caused by systemic small arterial spasm, endothelial cell damage, increased permeability, while systemic small arterial spasm causes ischemia and hypoxia of various tissues and organs, Microvascular lesions and increased vascular fragility cause a hematoma in the birth canal.

2, the labor process is too fast: the soft birth canal has not been fully expanded, the impact of the fetal head drop directly causes tissue damage or tearing of deep blood vessels, leading to the formation of hematoma in the birth canal. In view of the relationship between the location of the hematoma and the position of the fetus, the left anterior occipital area is prone to hematoma of the right vaginal wall, and the posterior occipital position is mostly anterior vaginal hematoma. The formation of a hematoma is considered to be the damage caused by the direct impact of the top of the fetal head on the vaginal wall.

3, perineal wound suture is not good: the blood vessels in the injury site are not sutured, continuous bleeding or bleeding, and hematoma.

4, coagulation dysfunction: pregnancy with thrombocytopenia, its hemostasis and coagulation function are reduced, while the fragility and permeability of capillaries increase, red blood cells easily escape, spontaneous bleeding occurs. In patients with pregnancy and hepatitis, the synthesis of prothrombin in the liver is reduced, or the content of vitamin K-dependent coagulation factors II, VII, IX, and X is reduced, causing coagulopathy and prolonged prothrombin time. These patients are more likely to develop hematoma when they encounter tissue damage.

an examination

Related inspection

Obstetric examination Obstetrics B super postpartum examination gynecological ultrasound examination vaginal gynecological routine examination

Therefore, patients with clinical hematoma should be examined:

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis.

Differential diagnosis

There are several types from where the hematoma occurs:

(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.

Different parts of the hematoma of the birth canal involve different blood vessels:

(1) descending branch of the uterine artery. It is thinner than the ascending branch, and is distributed in the cervix and the upper part of the vagina called the cervix---vaginal branch.

(2) vaginal artery. Branches of the anterior trunk of the hip internal artery, many small branches distributed in the lower part of the vagina, the top of the bladder and the neck of the bladder, and the descending branch of the uterine artery, forming a longitudinal vaginal artery, which descends from the anterior and posterior walls of the vagina.

(3) internal pudendal artery. The final branch of the anterior hip internal artery, from the ischial hole to the perineum and the anus is divided into 4 branches: the infraorbital artery, the rectum and the anus are supplied: the perineal artery, and the veins of each part are accompanied by the artery of the same name, and the number is compared. There are many arteries, and venous plexus is formed around the corresponding organs, and they are consistent with each other, so there are more chances of injury than arteries.

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