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CC BY-NC-ND 4.0 · AJP Rep 2021; 11(01): e34-e37
DOI: 10.1055/s-0040-1722727
Case Report

Spontaneous Broad Ligament Hematoma after Vaginal Delivery Requiring Hysterectomy

Megan Varvoutis
3   Division of Maternal Fetal Medicine, Duke University, Durham, North Carolina
,
Nguyen Thao Thi Nguyen
2   Duke University School of Medicine, Durham, North Carolina
,
Chad Grotegut
1   Division of Maternal Fetal Medicine, West VIrginia University, Morgantown, West Virginia
3   Division of Maternal Fetal Medicine, Duke University, Durham, North Carolina
› Author Affiliations Funding The authors have no relevant financial disclosures to disclose as no funding was used from a commercial organization.
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Abstract

Background Broad ligament hematomas are rare in the setting of vaginal delivery. When they do occur, patients typically present with acute hemodynamic instability. No cases of infected broad ligament hematomas have been reported.

Case A 22-year-old G2 P1011 status post vaginal delivery complicated by chorioamnionitis and pre-eclampsia presented 5 days postpartum with subjective complaints of fever, vomiting, and increased vaginal bleeding. She was treated with antibiotics and uterine evacuation was planned for presumed retained products. After dilation and curettage, the patient was transferred to our facility, as her clinical status did not improve, and was later found to have an infected broad ligament hematoma requiring hysterectomy.

Conclusion Though uncommon, broad ligament hematomas should be considered in postpartum women presenting with anemia and vaginal bleeding, even without hemodynamic instability. Recent intrauterine infections may predispose to hematoma infection.

Keywords

hysterectomy - broad ligament - spontaneous hematoma - sepsis


Publication History

Received: 15 March 2020

Accepted: 21 May 2020

Article published online:
18 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ziereisen V, Bellens B, Gérard C, Baeyens L. [Spontaneous rupture of utero-ovarian vessels in postpartal period: a case report and review of the literature]. J Gynecol Obstet Biol Reprod (Paris) 2003; 32 (01) 51-54
    PubMedSearch in Google Scholar
  • 2 Saleem N, Ali HS, Irfan A, Afzal B. Broad ligament hematoma following a vaginal delivery in primigravida. Pak J Med Sci 2009; 25 (04) 683-685
    PubMedSearch in Google Scholar
  • 3 Kovo M, Eshed I, Malinger G. Broad ligament hematoma following a normal vaginal delivery. Gynecol Surg 2006; 3 (02) 138-140
    CrossrefPubMedSearch in Google Scholar
  • 4 Zhang L, Fishman MC, Huang PL. Estrogen mediates the protective effects of pregnancy and chorionic gonadotropin in a mouse model of vascular injury. Arterioscler Thromb Vasc Biol 1999; 19 (09) 2059-2065
    CrossrefPubMedSearch in Google Scholar
  • 5 Lee HJ, Na ED, Kim HC, Kim MS, Moon MJ. Massive broad ligament hematoma caused by spontaneous uterine artery rupture after uncomplicated vaginal delivery. J Minim Invasive Gynecol 2020; 27 (02) 250-253
    CrossrefPubMedSearch in Google Scholar
  • 6 Maxwell C, Gawler D, Green J. An unusual case of acute postpartum broad ligament haematoma. Aust N Z J Obstet Gynaecol 1997; 37 (02) 239-241
    CrossrefPubMedSearch in Google Scholar
  • 7 Rouse DJ, Landon M, Leveno KJ. et al; National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network. The Maternal-Fetal Medicine Units cesarean registry: chorioamnionitis at term and its duration-relationship to outcomes. Am J Obstet Gynecol 2004; 191 (01) 211-216
    CrossrefPubMedSearch in Google Scholar