This presentation has a complete description of Vulvo-Vaginal hematoma, its causes , clinical features and management strategy. Hematoma can happen in case of episiotomy given during childbirth
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
The acute scrotum is the painful, swollen scrotum or its contents of sudden onset. The “acute scrotum” may be viewed as the urologist’s equivalent to the general surgeon’s “acute abdomen.” Scrotal emergencies are rare but potentially life and fertility threatening. The most common causes of acute scrotal pain in adults are testicular torsion and epididymitis.
Patients with scrotal pain less than the age of 16 have torsion until proven otherwise. Scrotal pain with nausea & vomiting is specific for torsion.
A small but real, negative exploration rate is acceptable to minimize the risk of missing a critical surgical diagnosis. TIME IS TESTICLE
Blood loss of >/ 500 ml within 24 hours of vaginal birth or 1000 ml after caesarean section or any blood loss sufficient to compromise haemodynamic instability
MINOR PPH- 500- 1000ml blood loss
MAJOR PPH- > 1000ml Blood loss
MASSIVE PPH- >2000ml Blood loss
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
7. WHAT IS UNIQUE TO VULVOVAGINAL
HEMATOMA
• Insidious in Onset,
• From Innocuous to
• Devastating
• Will happen in VIPs
• COMPLICATE an already
exhausted obstetrician’s life…..
8. Pregnant uterus, Vagina, Vulva
have rich vascular supplies that
are at risk of Trauma during the
birth process ~Hematoma
Puerperal hematomas occur 1:300
to 1:1500 deliveries
a potential life threatening
complication of childbirth .
10. WHO ARE AT RISK
FOR PUERPERAL
HEMATOMAS
Primiparas
OVD,
Episiotomy (85-
90%)
Big babies Over 4kg
PIH
, Prolonged second
stage
Multifetal preg
Precipitate labour
Other reasons
Vulvar Varicosities
Clotting Disorder
Injury to BV,
Pseudo Aneurysm ,
Traumatic AV fistula
Saleem Z, Rydhstrom H. Vaginal hematoma during parturition: a population-based study.
Acta Obstet Gynecol Scand 2004;83:560–2
11.
12. DETRIMENTAL TO VVH
DELAYED DIAGNOSIS
INCOMPLETE ,INAPPROPRIATE MANAGEMENT
DO IT RIGHT THE FIRST TIME
20/08/2021
Obstetric Update Bhagalpur 12
14. Vaginal venous
plexus surrounds
the vagina
Entire venous pool
becomes
tremendously
engorged during
the latter months
of pregnancy
WHAT WILL BLEED
15. WHAT WILL BLEED?!?
20/08/2021
Obstetric Update Bhagalpur 15
Vulva — Most vulval hematomas result from injuries to
branches of the pudendal artery
(inferior rectal,
perineal,
posterior labial,
and urethral arteries; the artery of the vestibule;
and the deep and dorsal arteries of the clitoris)
that occur during episiotomy or from perineal lacerations
Vaginal/paravaginal hematomas result from injuries to
branches of the
uterine artery, mainly the descending branch ,vaginal.
AND THE RICH VENOUS PLEXUS
16. Copyrights apply
Most vulvar hematomas result from injuries to branches of the pudendal
artery (inferior rectal, perineal, posterior labial, and urethral arteries; the
artery of the vestibule; and the deep and dorsal arteries of the clitoris) that
occur during episiotomy or from perineal lacerations
These vessels are typically located in the superficial fascia of the anterior
(urogenital) or posterior pelvic triangle
The superficial compartment of the anterior triangle communicates with the
subfascial space of the lower abdomen below the inguinal ligament.
Extension of bleeding in the anterior triangle is limited by Colles' fascia and
the urogenital diaphragm, while the anal fascia limits extension of bleeding
in the posterior triangle.
As a result, bleeding is directed toward the skin where the loose
subcutaneous tissues afford little resistance to hematoma formation.
Superficial hematomas can extend from the posterior margin of the
anterior triangle (at the level of the transverse perineal muscle) anteriorly
over the mons to the fusion of fascia at the inguinal ligament. Necrosis
caused by pressure and rupture of the tissue surrounding the hematoma
may lead to external hemorrhage
17. Vessels in the vagina are
surrounded by soft tissue
and do not lie in the
superficial fascia;
therefore, trauma to these
vessels can lead to a large
accumulation of blood in
the paravaginal space or
ischiorectal fossa
18. •Infra levator :
• vulval or
vulvo vaginal 2 ,3
• Supra levator:
Paravaginal or
supravaginal /
subperitoneal 1
19. • Vulvovaginal
haematoma
injury to br of
Pudendal art…
Broad ligament
• haematoma
• Uterine ,Cervical
,vaginal art
20/08/2021
Obstetric Update Bhagalpur 19
20. Pathogenesis
Two thirds due to failure to
achieve hemostasis particularly at
the upper end of incision / tear deep
ext of episiotomy
Can occur without perineal
laceration / incision due to
stretching and avulsion of vessels
during delivery
Sheikh GN. Perinatal genital hematomas. Obstet Gynecol 1971; 3: 571–5
21. CLINICAL FEATURES AND DIAGNOSIS
Symptoms develop insidiously in first 24 hrs
Manifest according to the Location
PAIN and MASS effect
Displacement of Vagina, Rectum ,Uterus
HEMODYNAMIC INSTABILITY
22. Presenting Symptoms and Signs
Cardiovascular collapse
Upward and lateral displacement of
uterus
Palpable bladder
Rectal pressure
Rectal or vaginal mass
Vaginal or vulval swelling
Continued vaginal bleeding
Severe rectal/ vaginal / perineal pain
TENESMUS
Discoloration and swelling
Urinary retention
23. Do we need any diagnostic modality
?
Diagnosis is Clinical
USG ,CT in Silent SL hematomas
24. Thorough physical examination of the
abdomen, vulva, vagina, and rectum
(including visual inspection of the external
genitalia, vagina, and cervix)
location and size of the hematoma
Recognition of a hematoma
prompt stabilization of the patient
26. Surgical management: Preoperative
considerations
General Measures
Maternal resuscitation
Assessment of blood loss and replacement
CBC, platelet count, coagulation profile
Informed consents
Antibiotics
Analgesics
OT
Adequate anesthesia, lighting and assistance
27. Management (Vulvar)
Conservative
Small nonexpanding haematoma < 3 cm (5 cm)
ice packs, analgesia ,frequent reassesments
.(Grade2C)
Prompt Surgical for expanding Hematoma
- Evacuation hemostasis and repair
- Evacuation hemostasis closed suction and vaginal packing
- Cervical and vaginal exploration for any tears,
repair by combined abdominal and vaginal approach
- Internal artery ligation
-
Arterial embolization
28. The skin over the hematoma is incised and the clot evacuated.
A suction/irrigation device may be helpful in clearing the clot and debris.
Detectable bleeding points should be ligated if identified;
however, in most cases, the lacerated vessel cannot be identified.
Bleeding leading to a vulvar hematoma is often venous and from multiple
sites.
The specific vessels may be difficult to isolate to control the bleeding
surgically.
the space created by the hematoma is approximated using interrupted or
figure-of-eight stitches of a fine, rapidly absorbable, synthetic suture such as
monocryl or polyglactin 910.
It is important to avoid putting extra foreign material into the wound, as this
increases the risk of infection.
Pressure is maintained by placing a pad and T bandage over the area for 12
hours. These maneuvers usually prevent recurrence of the hematoma, even
though a causative vessel was not identified and ligated. We do not pack or
29. Surgical management: Supralevator
More complicated due to extension into retroperitoneal space / broad ligament
Exploration of cervix and upper vagina and repair of tears
Full thickness
Interrupted sutures
Ensure identification of apex
If apex not identified then a combined
vaginal and abdominal approach for evacuation, hemostasis and repair
The proximity of the bladder anteriorly, small bowel and rectum posteriorly, and the
ureters and uterine vessels deep in the lateral vaginal fornices are important to
consider when closing the defect, as they can be included in placement of large deep
sutures
Internal artery ligation U/L or B/L
Hysterectomy
30.
31. Arterial embolization
Usually indicated in haematomas with intractable bleeding usually
supralevator
Bloom AI et al Arterial embolisation for persistent primary postpartum haemorrhage: before or after hysterectomy? BJOG
2004;111:880–4.
Pelvic Packing for Intractable
Obstetric Hemorrhage After
Emergency Peripartum Hysterectomy:
A Review
Omar Touhami 1, Arij Bouzid 2, Sofiene
Ben Marzouk 3, Mahdi Kehila 4, Mohamed
Badis Channoufi 5, Hayen El Magherbi 6
Oobstet gynecol 2018
Pelvic packing should be part of the
armamentarium available to the
obstetrician whenever intractable pelvic
hemorrhage is encountered
•. 2018
•. 2018
32. Quoting a case of Dr Girija
Shared in ICOG PPH
Panel of TRAUMATIC
PPH
A pt who had
RECURRENT VV H
,Twice managed in
Periphery prior to referral
Pt needed CT ,AP
approach and IIL finally
33.
34.
35.
36.
37. Postoperative considerations
Adequate replacement of blood and blood components
Careful observation in a high dependency ward for 12-24 hrs
Observe for recurrence
Antibiotics
Analgesics
Measures to reduce thromboembolism
Compression stockings, leg exercises
SRC for 24 hrs
38. Prevention
Ensure complete hemostasis SLOW & STEADY ,EPI
Early detection( Post delivery I hr later PV) Vitals Pain
Correct assessment of blood loss and replacement
Early recourse to surgery DO IT RIGHT FIRST
Antibiotics
Documentation
40. LESSONS LEARNT
The most important factor in correct diagnosis is clinical awareness and
high index of suspicion
Excessive perineal pain is a hallmark symptom: its presence should
prompt examination
Aggressive fluid resuscitation/blood transfusion may be required
Coagulation status should be monitored
Treatment should be carried out in an operating theatre
41. A urinary catheter should be used to prevent urinary retention and monitor
fluid balance
The threshold for using antibiotics should be low
There is no evidence to support best management, which can be primary
repair or packing, with or without insertion of a drain
Vigilance should be maintained after primary repair / packing, as recurrence
is common
Proper documentation and communication can reduce the chances of
litigation
LESSONS LEARNT
42. HAVE YOU MANAGED A HEMATOMA OF YOURS OR OF A COLLEAGUE
CAN YOU EVER FORGET THE PATIENTS?
MY TWO PENCE , Delay the suturing but don’t delay the diagnosis
Be a bit slow ..not too fast ..we are the best person to diagnose the hematoma
…So if it’s a big episiotomy more reason not to rush …
DEEP EPISIOTOMY, Close Muscle in two layers, PR,…Post Delivery
Assessment
Don’t ignore vessels or blood filling up..a bleeding vessel doesn’t disappear ..it
will cause havoc if its ignored .Layer by layer HEMOSTASIS.
POST OP PERIOD ..If Pt is C/O unbearable pain Pressure in rectum this could
be a vaginal hematoma
HONEST OPINION POLL
43. An Rh Negative booked G3P0A2 Full term
preg delivered normally with episiotomy
Was living at a distance, Pt complained of Pain
unrelentlessly
NOD gave injectable Voveran two times and
dismissed the complaints
Perineal care done
Morning round at 8am Pt very uncomfortable
though Happy at having delivered Vaginally
and a healthy baby,
Not ok with pain
PV done Barely could put my finger …..
OT, Anaesthetist, Blood Transfusion Drained
the hematoma,
Ensured Hemostasis …..
A horror
story …..20
years ago
Pt always came back to me but to remind me would mention
..Main Wo HEMATOMA waali pt…
44. Primi FTP last minute conversion
Platelets 80000
Counselled ,advised referral ,admitted on 27th July
Induced by cerviprime gel ,very fast progress,Took her in OT for
Section Fetal distress ,Bearing down ,Delivered in OT by vacuum
and Episiotomy .
Despite Careful ,meticulous suturing ,Hematoma diagnosed within
2 hours
Investigations sent hemogram ,Coagulation profile ,Consent ,In OT
again ,Under Spinal anesthesia ,with a colleague ,Drained the
hematoma ,and closed dead space ensuring hemostasis .
I was mentally ,Physically ,Medicolegally prepared for NEXT
PROCEDURE IIAL in this case
45. This Photo by Unknown Author is licensed under CC BY-SA-NC
The management of puerperal hematomas is based on practice patterns established over the years, rather than clinical trials with clearly defined outcomes.
if the hematoma was >5 cm or had estimated volume >200 mL
