ABSTRACT
Puerperal hematoma is a grave but fortunately rare hemorrhagic post-partum complication (occurring in less than 1:1000 deliveries). The hematoma arises due to detachment of para-vaginal conjunctive tissue. In this type of tissue, no natural hemostasis take place and the hematoma may spread into the retroperitoneal cavity. The different risk factors include primiparity, instrumental extraction of the foetus, pre-eclampsia, twin pregnancy and the presence of vulvo-vaginal varicose veins. External bleeding may not always be evident and other clinical symptoms may be delayed. Despite this, rapid course may still occur with drastic consequences. When a case is referred, an examination of the vulvo-vaginal region is mandatory, resuscitation and surgery performed immediately. If this fails angiographic embolization should be carried out. The prognostic outcome of this rare case of post-partum hemorrhagia is highly dependent on early diagnosis and rapid treatment involving close cooperation between obstetricians and anesthetists, and also of rapid embolization to prevent possible intractable hematomas.
Subject(s)
Hematoma/complications , Postpartum Hemorrhage/etiology , Thrombosis/complications , Vaginal Diseases/complications , Vulvar Diseases/complications , Adult , Female , Hematoma/diagnosis , Hematoma/therapy , Humans , Pregnancy , Risk Factors , Thrombosis/diagnosis , Thrombosis/therapy , Vaginal Diseases/diagnosis , Vaginal Diseases/therapy , Vulvar Diseases/diagnosis , Vulvar Diseases/therapyABSTRACT
Many publications report the number of epidural analgesias carried out for the last years in English-speaking countries. On the other hand, very little information exists about the incidence of obstetrical epidural analgesia performed in South and Central Europe, particularly in France. A retrospective study within the regions of Bourgogne and Franche-Comté was carried out for the year 1993 firstly, to determine the number of obstetrical epidural analgesias performed and the drugs used; and secondly, to describe the organization and the problems encountered. The result of this study leads to one major question: what is the best type of organization in order to guarantee the highest safety, given the increasing demand for epidural analgesia in obstetrics?
