Introduction

Postpartum hematomas are defined as collection of the blood in genital tract after cesarean delivery or vaginal delivery. Most postpartum hematomas arise from the lacerations of the genital tract due to operative vaginal delivery or due to injury to the pelvic blood vessels. Hematomas are devided in to three broad classes vulvar, vaginal, subperitoneal hmatoma. Postpartum pelvic haematomas are very rare after a normal vaginal delivery. The clinical features of  the postpartum hematoma may vary from incidental finding on pelvic examination or ultrasonography to the life-threatening bleeding detected with few hours of delivery (<24 hour). Lacerations leading to bleeding are major risk factors for formation of hematoma which occur from an operative vaginal delivery and injury to blood vessels of the pelvisdue to uterine evacuation or perforation. Others risk factors include big baby, prolong labour, multifetal gestation, coagulation disorder, vulvar varicosities. A postpartum hematoma is considered life threatening when it compromise the hemodynamic status and cardiovascular stability of the patient. Management guidelines of pelvic hematomas are not well established because they are rare hamatomas. Management option for small hematoma is conservative with watchful expectancy and large expanding hematomas are managed with emergent laparotomy. In this study we report a rare case of postpartum extrapritoneal pelvic haematoma after an uneventful vaginal delivery which was managed successfully by laparotomy.

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Dr Kamini Randhawa

Junior Resident, Department of Anesthesiology, IGMC Shimla, India