Abstract

Background: Broad ligament hematomas are rare, but potentially life-threatening complications following vaginal delivery. This can cause concealed hemorrhage and hemodynamic instability, necessitating prompt diagnosis and intervention. Effective management often requires a multidisciplinary approach to prevent maternal morbidities and mortalities. Case: An 18-year-old woman developed a large broad ligament hematoma and hypovolemic shock following a normal vaginal delivery. She was transferred to our tertiary care center on postpartum day one with persistent hypotension, requiring intensive resuscitation and uterine artery embolization. Her condition was further complicated by acute renal failure, disseminated intravascular coagulation (DIC), and respiratory distress, necessitating intubation, multiple blood product transfusions, and hemodialysis. The patient recovered completely with aggressive multidisciplinary management involving interventional radiology, critical care, and nephrology.

• 1.   Sadiku OD, Nair A, Said M, et al. Approaches to the prevention and treatment of postpartum hemorrhage: a systematic review of past advances, recent developments, and best practices. Cureus. 2024 Jul 22;16(7):e65096. doi:10.7759/cureus.65096
• 2.   Wormer KC, Seligman NS, Hockstein M. Postpartum Hemorrhage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jul 19. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK538279/
• 3.   Mathesan M, Sharma N. A rare case of broad ligament hematoma following vaginal delivery. Cureus. 2024 Jun 11;16(6):e62205.
• 4.   Kurakula S, Muralidharan V, N N, et al. Incidental finding of a broad ligament hematoma during tubal ligation surgery: a case report and literature review. Cureus. 2023 Jun 8;15(6):e40120. doi:10.7759/cureus.40120
• 5.   Brown M, Pasic M, Zehtabchi S, et al. Uterine artery embolization for primary postpartum hemorrhage. Tech Vasc Interv Radiol. 2021;24(1):100727. doi:10.1016/j. tvir.2021.100727
• 6.   Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, Cheng LU. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020;33:693–705. doi:10.1080/14767058.2 018.1497599.
• 7.   Lindquist JD, Vogelzang RL. Pelvic artery embolization for treatment of postpartum hemorrhage. Semin Intervent Radiol. 2018;35(1):41–47. doi:10.1055/s-0038-1636520.
• 8.   Shu H, Nie F. Clinical characteristics and prognosis of postpartum acute kidney injury. J Int Med Res. 2021;49(2):300060520988388. doi:10.1177/0300060520988388.
• 9.   Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis, and management. Obstet Anesth Dig. 2016 Sep;36(3):125–126. doi:10.1097/01. aoa.0000489443.83392.cf.
• 10.   Toh CH, Hoots WK; SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost.2007 Mar;5(3):604-6. doi: 10.1111/j.1538- 7836.2007.02313.x. Epub 2006 Nov 10. PMID: 17096704.

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