PELVIC HAEMATOMA

DEFINITION: Collection of blood anywhere in the area between the pelvic peritoneum and the perineal skin is called pelvic hematoma.

ANATOMICAL TYPES: Depending upon the location of the hematoma, whether below or above the levator ani, it is termed as:

- Infralevator hematoma—common

- Supralevator hematoma—rare.

INFRALEVATOR HEMATOMA:

The commonest one is the vulval hematoma.

Etiology:

1) Improper hemostasis during repair of vaginal or perineal tears or episiotomy wound—

• Failure to take precaution while suturing the apex of the tear
• Failure to obliterate the dead space while suturing the vaginal walls.

2) Rupture of paravaginal venous plexus either spontaneously or following instrumental delivery.

SYMPTOMS:

1) Persistent, severe pain on the perineal region.

2) There may be rectal tenesmus or bearing down efforts when extension occurs to the is chiorectal fossa. There may be even retention of urine.

SIGNS:

1) Variable degrees of shock may be evident.

2) Local examination reveals a tense swelling at the vulva which becomes dusky and purple in color and tender to touch.

SUPRALEVATOR HEMATOMA:

CAUSES—

(1) Extension of cervical laceration or primary colporrhexis (vault rupture).

(2) Lower uterine segment rupture.

(3) Spontaneous rupture of paravaginal venous plexus adjacent to the vault.

DIAGNOSIS: The diagnosis is usually late as pain is not of a conspicuous nature and so also the vaginal bleeding. Unexplained shock with features of internal hemorrhage following delivery raises the suspicion. Abdominal examination reveals a swelling above the inguinal ligament pushing the uterus to the contralateral side. Vaginal examination reveals: -

(a) Occlusion of the vaginal canal by a bulge or

(b) A boggy swelling felt through the fornix. Rectal examination corroborates the presence of the boggy mass. Ultrasonography may be needed for exact localization of the hematoma.

HOMOEOPATHIC MEDICINES FOR MANAGING PELVIC HAEMATOMA: -

There are many Homoeopathic remedies which have favorably tackled many cases of Pelvic Haematoma with effective results.

THE MEDICINES ARE: -

• Arnica Montana
• Bellis perennis
• Ledum palustre
• Phosphorus
• Sulphuricum acidum
• Calcarea phosphorica