| Popis: |
Postpartum hemorrhage is the leading cause of maternal mortality, ranging from 18 to 50% of deaths worldwide. The puerperal hematoma is an unusual cause (also called peri-genital thrombi) with a frequency of 1/1000. They are formed in a paravaginal, paracervical or parametrial connective detachment, after vascular lesions. There are many favorable factors: primiparity, instrumental extraction, macrosomia, multiple pregnancies, vulvovaginalvarices, difficult hemostasis, coagulation anomalies, and prolonged dilation. The “active” treatment of puerperal hematoma is based on surgery and/or arterial embolization. We report the case of a 23-year-old patient Para 2 Gravida 2, was admitted to our structure for immediate postpartum hemodynamic instability with puerperal hematoma, after spontaneous vaginal delivery of a male neonate weighing 4400 g. The physical examination on admission found a patient conscious, pale, collapsed; and the gynecological examination found a huge puerperal hematoma of 17cm/15 cm, with a cervical lesion. The patient´s condition began immediately in the emergency room. In the operating theater and under sedation; the puerperal hematoma was drained and the cervical lesion was sutured. A transfusion of 3 blood cells was sufficient for hemodynamic stability. The role of the anesthesiologist in management of obstetric hemorrhage is to maintain an optimal circulatory and respiratory state, to correct any coagulation disorders, while the obstetrician provides hemostasis gestures. |
