经阴道分娩阔韧带裂伤致产后出血一例并文献复习

Postpartum Hemorrhage Caused by Laceration of Broad Ligament in Vaginal Delivery:A Case Report and Literature Review

产后出血是分娩期常见并发症。然而,经阴道分娩阔韧带裂伤致产后出血罕见。报告1例28岁初产妇,因停经39^(+5)周,无产兆待产入院,既往病史未见异常,孕期产检正常,经阴道自然分娩,产程顺利。产后4 h出现呕吐、面色苍白,心率增快、血压下降,血红蛋白降低以及腹腔穿刺抽出不凝血等症状及体征,诊断为腹腔出血。急诊行小切口配合无气腹腹腔镜探查术,发现左侧阔韧带有一处破裂口,血管夹夹闭血管,缝合阔韧带,手术顺利,预后良好。通过对上述病例的回顾学习,总结得出产前需要充分评估孕妇的身体状况、骨盆条件以及胎儿情况,选择合适的分娩方式。阴道分娩过程中,注意引导孕妇正确用力,避免过分施压。产后发生出血时要及早识别症状及体征,做出正确处理,对于隐匿部位(阔韧带等)出血难以判断时,选择剖腹或腹腔镜探查诊治是关键。

Postpartum hemorrhage is a common complication during delivery.However,postpartum hemorrhage caused by broad ligament laceration during vaginal delivery is rare.A 28-year-old primigravida was admitted to the hospital with 39^(+5) weeks of stopping menstruation,no signs of labor awaiting delivery.There was no abnormality in the past medical history,and the pregnancy examination was normal and spontaneous vaginal delivery with an uneventful labor.Four hours after delivery,the patient presented symptoms and signs such as vomiting,pale face,increased heart rate,decreased blood pressure,decreased hemoglobin,and non-clotting blood extracted by abdominal puncture,which were diagnosed as abdominal hemorrhage.We performed emergency small incision combined with gasless laparoscopy and found a rupture in the left broad ligament.Vascular clamp was used to clamp the blood vessel and suture the broad ligament.The operation was successful and the prognosis was good.Through the review and study of the above case,it is concluded that in order to choose the right way of delivery,the prenatal need to fully evaluated the physical condition of the pregnant women,pelvic conditions and fetal conditions.During vaginal delivery,attention should be paid to guide pregnant women to exert proper force and avoid excessive pressure.In case of postpartum hemorrhage,it is necessary to identify symptoms and signs as early as possible and make proper treatment.Laparotomy or laparoscopic exploration is the key when it is difficult to diagnose bleeding in hidden areas(broad ligament,etc.).