Tohoku J. Exp. Med., 2019 October, 249(2)

Establishing a Treatment Algorithm for Puerperal Genital Hematoma Based on the Clinical Findings

SHU SOEDA,¹ HYO KYOZUKA,¹ ASAMI KATO,¹ TOMA FUKUDA,¹ HIROTAKA ISOGAMI,¹ MARINA WADA,¹ TSUYOSHI MURATA,¹ TSUYOSHI HIRAIWA,¹ SHUN YASUDA,¹ DAISHUKE SUZUKI,² AKIKO YAMAGUCHI,¹ OSAMU HASEGAWA,³ YASUHISA NOMURA,¹ MASATOSHI JIMBO,² TOSHIFUMI TAKAHASHI,² TAKAFUMI WATANABE,¹ HIDEKI MIZUNUMA² and KEIYA FUJIMORI¹

¹Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
²Fukushima Medical Center for Children and Women, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
³Department of Radiology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan

Postpartum hemorrhage within 24 hours after delivery remains the leading cause of maternal mortality worldwide. Puerperal genital hematoma (PGHA) is a rare complication of postpartum hemorrhage, and PGHA can be life-threatening if hemostasis is not properly achieved. However, a reliable management algorithm for PGHA based on the clinical findings has not been developed. The objectives were to evaluate the management strategies for PGHA and identify the clinical findings that help select the treatment for PGHA. The medical records of women who were treated for PGHA in our department were reviewed, and data regarding the clinical findings and the treatment strategy for PGHA were analyzed. Thirty-four women who underwent treatment for PGHA were identified and divided into three groups according to the final procedure that achieved hemostasis: conservative management (CM) (n = 9), surgical management (SURG) (n = 15), and arterial embolization management (AEM) (n = 10). Regarding the clinical findings on initial evaluation, the shock index was significantly higher in the AEM group than in the CM or SURG group; and initial platelet count and fibrinogen level were significantly lower in the AEM group than in the CM group. There was no significant difference in any computed tomography (CT) finding among the three groups. In conclusion, this study clearly shows the difference in clinical findings among treatment strategies for PGHA. We suggest that the clinical findings of shock index, platelet count, and fibrinogen level together with CT findings are helpful and valuable for selecting the treatment strategy for PGHA.

Keywords —— arterial embolization; clinical findings; conservative management; puerperal genital hematoma; treatment algorithm

© 2019 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2019, 249, 135-142

Correspondence: Shu Soeda, M.D., Ph.D., Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.

e-mail: s-soeda@fmu.ac.jp