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Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges

Maternal-Fetal Medicine 2024年第4期6卷 232-235页

作者： JM Palacios-Jaraquemada AJ Nieto-Calvache AN Basanta Department of Obstetrics and Gynecology CEMIC University HospitalBuenos Aires C1431Argentina Anatomy Department School of MedicineUniversity of Buenos AiresBuenos Aires C1427Argentina Department of Obstetrics and Gynecology Fundación Valle del LiliCentro de Investigaciones ClínicasCali 760032Colombia Department of Obstetrics and Gynecology Fernández HospitalBuenos Aires C1427Argentina.

Objective To describe the challenges in diagnosing concealed postpartum bleeding,a rare but potentially life-threatening condition,and to highlight key factors in identifying and managing this *** We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected,focusing on the role of imaging,serologic markers,and *** examined instances of hemodynamic instability,the utility of pelvic space analysis via computed tomography,and the limitations of digital angiography,particularly in identifying bleeding sources in the posterior iliac internal artery *** Concealed postpartum bleeding often originates from venous damage or,less commonly,arterial *** instability was noted to occur periodically,despite negative findings on vaginal examination and ultrasound,leading to diagnostic *** angiography often yields negative results when the focus is limited to the anterior division of the internal iliac *** typically arises from damage to the vaginal muscular layer or levator ani muscle,both supplied by branches of the internal pudendal artery(posterior iliac division).In some cases,laparotomy also failed to locate the source due to the bleeding being in the subperitoneal *** Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results.A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are *** expertise,along with serologic markers of hidden bleeding,is essential for timely diagnosis and management.

关键词： Concealed postpartum bleeding Extrauterine postpartum bleeding puerperal hematomas

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