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Large supralevator haematoma: a dilemma in diagnosis and management
  1. Nipasa Sarma1,
  2. Shripad Hebbar2 and
  3. Ruthvika Kundoor1
  1. 1Junior Resident, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of higher education, Manipal, Karnataka, India
  2. 2Professor and Head, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of higher education, Manipal, Karnataka, India
  1. Correspondence to Dr Nipasa Sarma; nipasasharma{at}; Dr Shripad Hebbar; shripad.hebbar{at}


This is a case of postpartum haemorrhage following vaginal delivery of a primigravida in her late 20s resulting from a supralevator haematoma. She delivered in a low-resource hospital setting, with a late diagnosis of severe pre-eclampsia and haemolysis, elevated liver enzymes and low platelet count (HELLP), subsequently developed traumatic postpartum haemorrhage and vaginal haematoma, and was referred to our hospital for further management. She was constantly monitored, and serial ultrasonography revealed an expanding paravaginal haematoma. CT, 4 hours after admission, showed a large ill-defined collection with hyperdense areas of blood attenuation measuring ~8.0×6.2×12.2 cm in toto in the vaginal canal and right paravaginal region with supralevator extension, abutting the rectum posteriorly. The expanding haematoma caused gradual hypovolaemic shock, and hence, she was taken up for vaginal evacuation of supralevator haematoma with drainage tube insertion under ultrasound guidance. She received multiple blood product transfusion. Drain tube was removed on postoperative day 3. Follow-up scan was done and resolving haematoma noted. The patient was discharged on postoperative day 5 in a stable condition. She was followed up in outpatient department, and there was complete resolution of haematoma by 4 weeks.

  • Obstetrics, gynaecology and fertility
  • Haematology (incl blood transfusion)
  • Pregnancy

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: NS and RK. The following authors gave final approval of the manuscript: SH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.