Massive Traumatic Postpartum Haemorrhage with Co-incidental Atypical Eclampsia and Abdominal Koch’s- A Maternal Near Miss

Abstract

Obstetric haemorrhage is related with augmented risk of maternal morbidity and mortality and continues to be the second greatest direct cause of near miss and maternal death. Postpartum Haemorrhage (PPH) is the most common form of obstetric haemorrhage, atonic PPH being responsible for 80% cases. Traumatic PPH with massive vulval haematoma, an infrequent but possibly fatal condition if left undiagnosed and untreated. Hence, prompt recognition and management with simultaneous resuscitation and operative procedure is vital to save life of mother. A 24-year-old P1L1 female with traumatic haemorrhage with the formation of massive vulval haematoma, periurethral tears, extensive cervical and vaginal wall tears with hypovolaemic shock with severe anaemia admitted to the tertiary care hospital. Immediate resuscitation measures were taken followed by vaginal exploration for the vulvovaginal haematoma and a multispeciality approach for the better outcome. However, postvaginal exploration after 24 hours, there was progression in vulvo vaginal haematoma size, with haemodynamic instability. Re-exploration under anaesthesia via abdominal approach was performed. The patient required a longer hospital stay. Thus, early diagnosis and treatment of puerperal haematomas can prevent significant complications.

Keywords

• haematoma
• hypovolaemic shock
• vulva