obsolete obstetrical pelvic hematoma

Obstetrical Pelvic Hematoma: An Obsolete Term

The term "obstetrical pelvic hematoma" is no longer commonly used in modern medical literature. However, it was previously associated with a rare and potentially life-threatening complication of childbirth.

• Definition: Obstetrical pelvic hematoma referred to a type of pelvic hematoma that occurred during or after delivery.
• Incidence: The incidence of obstetrical pelvic hematomas was reported to be around 1:300 to 1:1500 deliveries [10].
• Causes: These hematomas were often caused by trauma to the richly vascularized tissues of the pregnant uterus, vagina, and vulva during delivery.
• Complications: Obstetrical pelvic hematomas could lead to severe hemorrhagic shock and potentially life-threatening complications.

Current Understanding

The term "obstetrical pelvic hematoma" is now largely obsolete, and the condition is more commonly referred to as a puerperal genital hematoma (PGHA) or simply a pelvic hematoma. The current understanding of these conditions emphasizes the importance of prompt recognition and management to prevent severe complications.

• Modern Terminology: PGHA is an infrequent but serious obstetrical complication associated with delivery, with an incidence ranging from 1 in 1500 to 1 in 210 [12].
• Risk Factors: The risk factors for pelvic hematomas include operative delivery, episiotomy, and other forms of trauma to the perineum and vaginal wall.

References

[10] The pregnant uterus, vagina, and vulva have rich vascular supplies that are at risk of trauma during the birth process, and trauma may result in formation of a hematoma. Puerperal hematomas occur in 1:300 to 1:1500 deliveries and, rarely, are a potentially life-threatening complication of childbirth [10].

[12] 1 INTRODUCTION. Puerperal genital hematoma (PGHA) is an infrequent but a serious obstetrical complication associated with delivery. Over the previous decade, the incidence of PGHA has been documented to range from around 1 in 1500 to 1 in 210 [12].

Based on the provided context, it appears that there are various diagnostic tests used to diagnose obstetric pelvic hematomas. Here are some of the diagnostic tests mentioned:

• Ultrasound: While not always diagnostic, ultrasound can be used as a first-line imaging test to evaluate for pelvic hematomas (8). If ultrasound is nondiagnostic, abdomino-pelvic CT may be indicated to precisely delineate the hematoma regardless of its location (9).
• Computed Tomography (CT) scan: CT imaging provides a clear view of the hematoma's location and size, making it helpful in making a definitive diagnosis (8). Postoperative contrast-enhanced CT revealed pulmonary embolism and massive right ovarian vein thrombosis (7).
• Magnetic Resonance Imaging (MRI): MRI can also be used to confirm the diagnosis of pelvic hematomas, although its use is not as commonly mentioned in the context.
• Digital Subtraction Angiography (DSA): DSA is considered the gold standard for diagnosing spontaneous uterine artery rupture, which may be related to obstetric pelvic hematomas (1-4).

It's worth noting that while these diagnostic tests can help confirm a diagnosis of obstetric pelvic hematoma, they are not always necessary. Clinical management and initial blood examinations can also provide valuable information in making a diagnosis.

References:

• [8] CT imaging provides a clear view of the hematoma's location and size and is helpful in making a definitive diagnosis.
• [9] If ultrasound is nondiagnostic, abdomino-pelvic CT is indicated as it precisely delineates the hematoma regardless of its location.
• [1-4] DSA is considered the gold standard for diagnosing spontaneous uterine artery rupture.

Based on the provided context, it appears that there are limited options for drug treatment of obstetric pelvic hematomas.

• Hormone-based contraceptives can be used in the prevention of hemorrhagic ovarian cysts in adults with Congenital Heart Disease (CHD), but their effectiveness in treating existing pelvic hematomas is unclear [4].
• Tranexamic acid, a medication that helps to reduce bleeding, has been shown to reduce 28-day mortality among patients with suspected bleeding, but its use in obstetric pelvic hematomas specifically is not mentioned [5].

It's worth noting that the context suggests that drug treatment may not be the primary approach for managing obstetric pelvic hematomas. Instead, other interventions such as transcatheter arterial embolization (TAE) or surgical treatments may be considered.

• Pelvic angiographic embolization is an alternative treatment modality in the treatment of many obstetric and gynecologic hemorrhages, including pelvic hematomas [14].
• Transcatheter arterial embolization should be selected for upper vaginal wall hematomas, suggesting that TAE may be a preferred treatment option for certain types of pelvic hematomas [15].

In summary, while there are some medications mentioned in the context that may have a role in preventing or treating related conditions (such as hemorrhagic ovarian cysts), it appears that drug treatment is not a primary approach for managing obstetric pelvic hematomas. Other interventions such as TAE or surgical treatments may be more effective.

References: [4] Connor BS, 2019 [5] 2023 [14] Context result 14 [15] Context result 15

Obstetrical Pelvic Hematoma Differential Diagnosis

A differential diagnosis for an obstetrical pelvic hematoma involves considering various possible causes, including:

• Spontaneous uterine artery rupture: This is a rare complication that should be considered in cases of unexplained pelvic hematoma [4].
• Retroperitoneal hematomas: These are rare in obstetrics but can occur due to multiple pregnancies or other risk factors [7].
• Rectus sheath hematoma: Although rare, this condition can present with similar symptoms and should be considered in the differential diagnosis [8].
• Pelvic lesions: A wide array of pelvic lesions can present with hemorrhage, including both benign and malignant conditions. Clinical history and MRI characteristics can often narrow the differential diagnosis and guide management [10].

Other Possible Causes

In addition to these specific conditions, other possible causes of obstetrical pelvic hematoma include:

• Uterine infection (endometritis): This should be considered in cases of late postpartum hemorrhage, particularly if accompanied by fever, chills, foul discharge, and elevated WBC count [12].
• Obstetric hemorrhage: This is a leading cause of maternal death worldwide and can present with profuse and continuous bleeding due to atonic uterus, vaginal/cervical lacerations, or uterine rupture [15].

References

[4] The possibility of spontaneous uterine artery rupture should be considered for unexplained pelvic hematoma. [7] Retroperitoneal hematomas are rare in obstetrics but can occur due to multiple pregnancies or other risk factors. [8] Rectus sheath hematoma is a rare clinical diagnosis, particularly in pregnancy. [10] A large spectrum of pathologic pelvic conditions can present with hemorrhage in structures or organs. [12] Consider uterine infection, or endometritis, particularly with late postpartum hemorrhage. [15] One of the leading causes of maternal morbidity and mortality worldwide is hemorrhage.