Management of postpartum vaginal haematomas by embolisation: Two cases

Mehdi Kehila; Sami Mahjoub; Sahbi Kebaili; Hatem Rajhi; Fouzia Zouari

doi:10.1684/san.2010.0194

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Management of postpartum vaginal haematomas by embolisation: Two cases

Cahiers d'études et de recherches francophones / Santé . Volume 20, Number 2, 105-7, avril-mai-juin 2010, Cas clinique

DOI : 10.1684/san.2010.0194

Résumé

Summary

Author(s) : Mehdi Kehila, Sami Mahjoub, Sahbi Kebaili, Hatem Rajhi, Fouzia Zouari , Service C de gynécologie-obstétrique Centre de maternité de Tunis Tunis Tunisie, Service de gynécologie-obstétrique de Sousse Sousse Tunisie, Service de radiologie Hôpital Charles-Nicole Tunis Tunisie.

Summary : Postpartum vaginal haematomas are a rare complication of delivery. The incidence of large haematomas is estimated at 1/4000 deliveries, and this complication can be life-threatening. We report two such cases. The diagnosis is suggested by shooting perineal pain with urinary tenesmus and vulvovaginal swelling or an unexplained haemorrhagic syndrome in the postpartum period. Rapid management is essential. Embolisation by interventional radiology is preferred to surgery. In the first case, arterial embolisation was performed after bilateral ligation of the hypogastric arteries failed. Arterial embolisation was the first-line treatment for the second patient. It was successful for both women.

Keywords : genital hematoma, gynaecology-obstetrics, post-partum hemorrhagia

Pictures

Figure 1 Cathétérisme hypersélectif de l'artère vaginale droite avec zones d'extravasation de produit de contraste au niveau périnéal (flèche).

Figure 1. Selective right vaginal artery angiogram shows extravasation of contrast product at the perineum (arrow).

Figure 2 Contrôle après embolisation montrant une occlusion de l'artère vaginale et une exclusion des zones d'extravasation de contraste.

Figure 2. Post-embolisation angiogram shows occlusion of embolised artery and no further extravasation.