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

作　　者：JM Palacios-Jaraquemada AJ Nieto-Calvache AN Basanta 

机构地区：[1]Department of Obstetrics and Gynecology,CEMIC University Hospital,Buenos Aires C1431,Argentina [2]Anatomy Department,School of Medicine,University of Buenos Aires,Buenos Aires C1427,Argentina [3]Department of Obstetrics and Gynecology,Fundación Valle del Lili,Centro de Investigaciones Clínicas,Cali 760032,Colombia [4]Department of Obstetrics and Gynecology,Fernández Hospital,Buenos Aires C1427,Argentina

出　　处：《Maternal-Fetal Medicine》2024年第4期232-235,共4页母胎医学杂志（英文）

摘　　要：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 condition.Methods: We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected,focusing on the role of imaging,serologic markers,and angiography.We 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 division.Results: Concealed postpartum bleeding often originates from venous damage or,less commonly,arterial injury.Hemodynamic instability was noted to occur periodically,despite negative findings on vaginal examination and ultrasound,leading to diagnostic delays.Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery.Bleeding 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 spaces.Conclusion: 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 crucial.Advanced 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 

分 类 号：R714[医药卫生—妇产科学]