Large Concealed Postpartum Supra Levator Pelvic Hematoma following an Uncomplicated Spontaneous Vaginal Birth - Successful Conservative Management of Supra Levator Component following Evacuation of Infralevator Paravaginal Hematoma

Sajira Bhasi, Sanket Shah, Edwin Chandraharan, Parashar Bharath — Sat, 31 Oct 2026 00:00:00 +0000

A primigravida of Asian origin, presented with a history of pre-labour rupture of membranes and abdominal pain at 37 weeks 6 days of gestation. Her BMI was 31, with an A-negative blood group and was diagnosed with Gestational Diabetes Mellitus (GDM) which was being managed with metformin. She developed gestational hypertension late in pregnancy, which was well controlled with Labetalol. She was also diagnosed to have Group B Streptococcus (GBS) colonisation of the vagina. Her labour progressed well and she had a normal spontaneous vaginal birth. Her immediate postnatal period was uneventful. After 3 hours of birth, the patient experienced pelvic pain and was diagnosed with a paravaginal hematoma. Examination under general anaesthesia with intra operative ultrasound was done. A lateral vaginal wall hematoma near right fornixes of 3- 4 cm was found and this was evacuated and haemostasis was achieved after the repair of the lateral vaginal wall. There were no cervical or vaginal lacerations. A vaginal pack was kept in situ for 12 hours and an indwelling bladder catheter was inserted for 12 hours. Intra-operative abdominal ultrasound scan revealed a pelvic haematoma with poorly defined margins. Hence, MRI of the pelvis with and without contrast was performed in the post-operative period and an occult large supra levator paravaginal hematoma (right vaginal forniceal hematoma with pelvic extension) was identified. The post-operative period was uneventful with a stable haemoglobin level and the patient was hemodynamically stable. Inputs from an interventional radiologist was obtained, and a joint decision was made for conservative management.

Why this Case is Unique

A spontaneous vaginal birth, with no traumatic tears, minimal blood loss, a normal Hb, but with 11.6 cm hematoma. A complete resolution occurred without the need for embolization.

CT Hypotension Complex (Shock Bowel) - A Pictorial Review of Imaging Features

Raginee Chandrakar, Sridhar P.G., Nisha Sreenivasan — Sat, 31 Oct 2026 00:00:00 +0000

The shock bowel sign and the broader CT hypotension complex are frequently triggered by severe systemic hypotension originating from medical conditions other than traumatic haemorrhagic shock. These include cardiac arrest, severe septic shock, neurogenic shock (secondary to critical craniocerebral or spinal cord injuries), bacterial endocarditis, and profound diabetic ketoacidosis (DKA).

The classic vascular and solid visceral elements of the hypoperfusion complex-such as the attenuation of the abdominal aorta and inferior vena cava, abnormal pancreatic contrast dynamics with peripancreatic fluid, and marked hypoperfusion of the liver and spleen-are variably paired with the shock bowel sign, regardless of whether the underlying trigger is post-traumatic blood loss or a medical cause of circulatory failure.

Recognizing the CT hypotension complex carries critical prognostic weight and immediate therapeutic implications, as it guides clinicians toward aggressive volume resuscitation rather than unnecessary operations. In the majority of clinical presentations, these diffuse hypoperfusion features can be successfully distinguished from localized direct bowel trauma or primary ischemic bowel injury.

Journal of Evolution of Medical and Dental Sciences

Large Concealed Postpartum Supra Levator Pelvic Hematoma following an Uncomplicated Spontaneous Vaginal Birth - Successful Conservative Management of Supra Levator Component following Evacuation of Infralevator Paravaginal Hematoma

CT Hypotension Complex (Shock Bowel) - A Pictorial Review of Imaging Features