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Lyons, Arthur W.: Post-Partum Hematoma
Volume 59 Number 2
DIVERTICULUM OF PREGNANT U'l'ERUS
397
stances it may seem feasible to undertake no attempt at exeision. If there is evidence of gross infection or alarming persistent hemorrhage after removal of an intimately adherent placenta, it may be necessary to remove the uterus, particularly when the diverticulum is so located that its excision is technically impossible. When a uterus with a demonstrated diverticulum has been left in situ, future pregnancy should receive close observation. Lipiodol studies of the uterine body would seem advisable before pregnaney is permitted. References 1. Schickele and Freund: Beitr. z. Geburtsh. u. Gynak., Leipz. 8: 267-293, 1904. 2. Batizfalvy, V.: Orvosi hetil. 81: 761·767, 1937. 3. DeLee, J. B., and Greenhill, J. P.: The Principles and Practice of Obstetrics, ed. 9, Philadelphia, 1947, W. B. Saunders. 4. Stander, H. J.: 'l'extbook of Obstetrics, 3rd revision, New York, 1945, D. AppletonCentury Company, Inc. 5. Hawkins, M. C., Jr.: AM. J. 0BST. & GYNEC. 50: 562-563, 1945.
Lyons, Arthur W.: Post-Partum Hematoma, New England J. Med. 240: 461, 1949. The material for this report was derived from Bon Secours Hospital, Baltimore, Md. A review of 1,250 vaginal deliveries revealed that there were three postpartum hematomas. The first two .were v~lvar in origin, requiring removal of episiotomy sutures, evacuation of the clot, and resuturing. The third was a late paravaginal hematoma, which occurred on the seventh postpartum day, seven days following the patient's discharge from the hospital. The patient had been delivered by median episiotomy (perineotomy) and low forceps. She returned to the emergency clinic complaining of severe perineal pain. Examination revealed a hard, symmetrical mass extending 10 em. above the pubis; a gaping infected episiotomy wound; a mass extending 7 em. inside the vagina on the left lateral wall. The temperature was 104.4° F., the pulse 140, and respiration 22. There were 2,860,000 red blood cells and 58 per cent hemoglobin. Treatment consisted of a blood transfusion, administration of penicillin and streptomycin, evacuation of the blood clot, and insertion of proper drainage. The patient responded satisfactorily to this therapy and was discharged. }'our months later the patient was admitted for a secondary perineorrphy. The author states that in a review of the literature from 1554 to 1948 he was able to collect only 188 cases of paravaginal hematoma. Many more must be unreported. The introduction of penicillin and streptomycin has almost eliminated fatalities, which JAMES PRATT MARR. formerly amounted to 8.3 and 9.5 per cent maternal mortality.
DIVERTICULUM OF PREGNANT U'l'ERUS
397
stances it may seem feasible to undertake no attempt at exeision. If there is evidence of gross infection or alarming persistent hemorrhage after removal of an intimately adherent placenta, it may be necessary to remove the uterus, particularly when the diverticulum is so located that its excision is technically impossible. When a uterus with a demonstrated diverticulum has been left in situ, future pregnancy should receive close observation. Lipiodol studies of the uterine body would seem advisable before pregnaney is permitted. References 1. Schickele and Freund: Beitr. z. Geburtsh. u. Gynak., Leipz. 8: 267-293, 1904. 2. Batizfalvy, V.: Orvosi hetil. 81: 761·767, 1937. 3. DeLee, J. B., and Greenhill, J. P.: The Principles and Practice of Obstetrics, ed. 9, Philadelphia, 1947, W. B. Saunders. 4. Stander, H. J.: 'l'extbook of Obstetrics, 3rd revision, New York, 1945, D. AppletonCentury Company, Inc. 5. Hawkins, M. C., Jr.: AM. J. 0BST. & GYNEC. 50: 562-563, 1945.
Lyons, Arthur W.: Post-Partum Hematoma, New England J. Med. 240: 461, 1949. The material for this report was derived from Bon Secours Hospital, Baltimore, Md. A review of 1,250 vaginal deliveries revealed that there were three postpartum hematomas. The first two .were v~lvar in origin, requiring removal of episiotomy sutures, evacuation of the clot, and resuturing. The third was a late paravaginal hematoma, which occurred on the seventh postpartum day, seven days following the patient's discharge from the hospital. The patient had been delivered by median episiotomy (perineotomy) and low forceps. She returned to the emergency clinic complaining of severe perineal pain. Examination revealed a hard, symmetrical mass extending 10 em. above the pubis; a gaping infected episiotomy wound; a mass extending 7 em. inside the vagina on the left lateral wall. The temperature was 104.4° F., the pulse 140, and respiration 22. There were 2,860,000 red blood cells and 58 per cent hemoglobin. Treatment consisted of a blood transfusion, administration of penicillin and streptomycin, evacuation of the blood clot, and insertion of proper drainage. The patient responded satisfactorily to this therapy and was discharged. }'our months later the patient was admitted for a secondary perineorrphy. The author states that in a review of the literature from 1554 to 1948 he was able to collect only 188 cases of paravaginal hematoma. Many more must be unreported. The introduction of penicillin and streptomycin has almost eliminated fatalities, which JAMES PRATT MARR. formerly amounted to 8.3 and 9.5 per cent maternal mortality.