Broad Ligament Haematoma



Broad ligament haematoma is one of the important emergencies faced in labour room with variable incidence between 1:500 and 1:20,000. It occurs due to obstetric trauma (lacerations/tear) to the cervix, upper vagina or uterus that extends into uterine or vaginal vessels or vessels of the broad ligament. The diagnosis is usually late as pain is not of a conspicuous nature and so also the vaginal bleeding. Unexplained shock with features of internal haemorrhage following delivery raises the suspicion. If not diagnosed in time, it can have fatal progress leading to maternal mortality. The definitive treatment of broad ligament haematomas is variable according to size, location and severity of patient. Thus strong clinical suspicion, prompt diagnosis and timely intervention are the important factors for successful treatment.


Supralevator haematoma Broad ligament haematoma Retroperitoneal haematoma Postpartum haemorrhage (PPH) Bilateral internal iliac ligation Selective arterial embolization 


  1. 1.
    Fliegner JR. Postpartum broad ligament haematomas. J Obstet Gynaecol Br Commonw. 1971;78:184–9.CrossRefGoogle Scholar
  2. 2.
    Hankins G, Zahn C. Puerperal haematomas and lower genital tract lacerations. In: Hankins G, et al., editors. Operative obstetrics. Norwalk, CT: Appleton and Lange; 1995. p. 57–72.Google Scholar
  3. 3.
    Cheung TH, Chang A. Puerperal haematomas. Asia-Oceania J Obstet Gynaecol. 1991;17:119–23.CrossRefGoogle Scholar
  4. 4.
    Williams JW. Subperitoneal hematoma following labor not associated with lesions of the uterus. Trans Am Gynecol Soc. 1904;29:186.Google Scholar
  5. 5.
    Addo V, Kokroe FA, Reindorf RL. Broad ligament haematoma following a Snake Bite. Ghana Med J. 2009;43:181–2.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Mirza FG, Gaddipati S. Obstetric emergencies. Semin Perinatol. 2009;33:97–103.CrossRefGoogle Scholar
  7. 7.
    Edmonds K. Dewhurst’s textbook of obstetrics and gynecology. 6th ed. London: Blackwell Science; 1999.Google Scholar
  8. 8.
    Mawhinney S, Holman R. Practice points puerperal genital haematoma: a commonly missed diagnosis. Obstet Gynaecol. 2007;9:195–200.Google Scholar
  9. 9.
    Bloom AI, Verstandig A, Gielchinsky Y, Nadiari M, Elchalal U. Arterial embolisation for persistent primary postpartum haemorrhage: before or after hysterectomy? BJOG. 2004;111:880.CrossRefGoogle Scholar
  10. 10.
    Badawy SZA, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M. Uterine artery embolization: the role in obstetrics and gynecology. Clin Imaging. 2001;25:288–95.CrossRefGoogle Scholar
  11. 11.
    Dildy GA 3rd. Postpartum haemorrhage: new management options. Clin Obstet Gynecol. 2002;45:330–44.CrossRefGoogle Scholar
  12. 12.
    Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18:849–52.CrossRefGoogle Scholar
  13. 13.
    Brown BJ, Heaston D, Poulson AM. Uncontrollable postpartum bleeding: a new approach to haemostasis through angiographic arterial embolization. Obstet Gynecol. 1979;54(3):361–5.PubMedGoogle Scholar
  14. 14.
    Heffner LJ, Mennuti MT, Rudoff JC, McLean GK. Primary management of postpartum vulvovaginal haematomas by angiographic embolization. Am J Perinatol. 1985;2(3):204–7.CrossRefGoogle Scholar
  15. 15.
    Chin HG, Scott DR, Resnik R, Davis GB, Lurie AL. Angiographic embolization of intractable puerperal haematomas. Am J Obstet Gynecol. 1989;160(2):434–8.CrossRefGoogle Scholar
  16. 16.
    Villella J, Garry D, Levine G, Glanz S, Figueroa R, Maulik D. Postpartum angiographic embolization for vulvovaginal haematoma: a report of two cases. J Reprod Med Obstet. 2001;46:65–7.Google Scholar
  17. 17.
    Bienstman-Pailleux J, Huissoud C, Dubernard G, Rudigoz RC. Management of puerperal haematomas. J Gynecol Obstet Biol Reprod (Paris). 2009;38:203–8.CrossRefGoogle Scholar
  18. 18.
    Goodwin SC, Walker WJ. Uterine artery embolization for the treatment of uterine fibroids. Curr Opin Obstet Gynecol. 1998;10(4):315–20.CrossRefGoogle Scholar
  19. 19.
    Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum haemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. 2007;62:540–7.CrossRefGoogle Scholar
  20. 20.
    Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Predictors of failed pelvic arterial embolization for severe postpartum haemorrhage. Obstet Gynecol. 2009;113:992–9.CrossRefGoogle Scholar
  21. 21.
    Dahdouh EM, Balayla J, Dube J. Angiographic embolization of a postpartum vulvovaginal haematoma in a patient with situs inversus totalis: an effective second line treatment. Case Rep Obstet Gynecol. 2013;2013:323781.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Benrubi G, Neuman C, Nuss RC, Thompson RJ. Vulvar and vaginal haematomas: a retrospective study of conservative versus operative management. South Med J. 1987;80(8):991–4.CrossRefGoogle Scholar
  23. 23.
    South Australian Perinatal Practice Guidelines. Puerperal genital haematomas. Adelaide: Dept of Health, Govt of South Australia; 2012.Google Scholar

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© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.MIMER Medical CollegePuneIndia
  2. 2.Biniwale ClinicPuneIndia

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