Parto vaginal complicado: hematoma vaginal disecante

Abstract

This degree work sets out the clinical case of a 18 years old patience, primitive, primiparous, who goes to Guamote Hospital for delivery care, is presented eight hours after spontaneous vaginal delivery presents vulvar edema, asthenia, vaginal bleeding, generalized paleness and signs of hypovolemia, resuscitation was initiated with crystalloids, uterotonics was administered, without obtaining improvement, so it required to be referred to the Riobamba General Provincial Teaching Hospital with a diagnosis of postpartum hemorrhage. A review of the vaginal canal and uterine cavity is performed, evidencing hematoma of the right lateral wall that is directed at the bottom of the vaginal sac, so it is decided to perform an emergency exploratory laparotomy after transfusion of red blood cell concentrates, where hematoma is observed on the lateral side right of uterus, base of round ligament and delimited pelvic infundibulum. During hospitalization, iron, antibiotic therapy, and pain therapy are administered, it evolves favorably and is discharged on the ninth day of hospitalization with corrected hemoglobin and hematocrit levels, follow-up by external consultation for 3 months, no complications are evidenced since discharge. Immediate recognition of postpartum hemorrhage, identification of its location, and timely and early treatment are the basics for reducing maternal mortality. In the case of this patient, a delay would have caused a fatal outcome for the patient.