A female aged 20 yrs. having pregnancy of 36 weeks duration with dead foetus is referred to surgery by the obstetrician for getting opinion about a huge left para vaginal swelling(photograph attached).It appeared to be a huge haemartoma blocking almost whole of vaginal opening. Needle aspiration revealed small amount of blood.Obstetrician doesn't want to do C S as the foetus is already dead. What should be done?

9 Likes

LikeAnswersShare

image shows fresh blood,mostly vulval hematoma .start antibiotic, correction of anemia,sent coagulation profile if abnormal correct it with ffp and prp.under anaesthesia evacuate it by medial incision and ligate bleeders and apply compression pack for 12-24hours.if transverse lie can do lacs simultaneously otherwise induction with Folly's after concent.

first of all do USG of for fetal presentation and USG of vulval growth to rule out is their any tissue elements in it or blood only.by seeing image it is fresh blood on growth mostly hematoma.sent coagulation profile urgently.CBC.keep 2-3 BT READY.FFP &PRP ACCORDING TO report of coagulation profile. if alter profile first correct it and then under anesthesia evacuate hematoma and ligate bleeding vessel and keep incision medially and give compression for 12-24 hours.start antibiotics before procedure.if transverse lie with iufd can do lacs simultaneously otherwise offer induction with folly' s catheter.

I think it is better to drain the hematoma,if there is active bleeder ligate it.then see the bishop score to find favourability of cervix.but try to find out the cause of iud.rule out abruption with coagulation failure.rule out rupture uterus also.keep blood and blood products ready

do serum fibrinogen,coagulation profile
2

View 2 other replies

it's looking like haematoma,but spontaneous haematoma in an IUD case,can be coagulation abnormalities , arrange for FFP,evacuate haematoma,proceed with vaginal mesoprost OK 400mg stat followed by 200mg q2hrly,with escalating doses of syntocinon,blood and blood products to be reserved dep on aptt,ptcheck lft,kft,platelet count,ser fibrinogen,take high risk consent,and trial of labour depending on DICscoring

DOES SHE IN LABOUR.MOST PROBABLY MEDDLING BY SOME UNTRAINED PEOPLE .IT SEEMS TO BE VULVAL EDEMA. BETTER DO A USG UNDER EXPERIENCED HAND RULE OUT ANY INTERNAL ISSUES. IF NO READY WITH COMPATABLE BLOOD, OBSERVE THIS HAEMATOMA INCREASIG OR STABLE. IF STABLE APPLY HOT PACKS & IF NO ACCORDING TIME ONSET OF IUD& COAGULATION PROFILE. THE SUBSIDES THEN PLAN FOR LSCS DEPENDING UPON THE SITUATION.

if it is a tumour/hematoma excise it and allow vaginal delivery. sometimes the mass may go to one side and allow passage of the fetus.

I agree that CS is not recommended in case of IUD baby. However confusion whether the lesion is Haematoma or Hamartoma. Clinically hematoma usually extreamly painful but hamartroma painless and compressible unless complicated by thrombosis. So in this situation High Resolution USG is useful tool also we can differentiate High flow lession from low flow lession. ..Once diagnosis is confirm we can drain the hematoma or excise the lesion if obstructing the pelvic outlet...

we can do an Incision and drainage of this large hematoma, but before doing that look for hemoglobin status and blood co-aggulation profile...

Need desperate OT, yes, in case of death foetus, the normal way is highly acceptable. then Brest milk suppression. here the case of hematoma, need a longitudinal incision and ligate the sputter and repair the area. after hematoma subsided, proceed for abortion . but 36 months is advanced stage, be careful. but as my opinion, use Catgut for repairing of skin area. Thank you.

it's hematoma and needs surgical drainage....

Load more answers

Diseases Related to Discussion