Nursing care of a parturient with broad ligament hematoma complicated with hemorrhagic shock in vaginal delivery

doi:10.3761/j.issn.0254-1769.2025.08.011

Abstract

Abstract:

To summarize the nursing experience of a case involving hemorrhagic shock caused by broad ligament hematoma in vaginal delivery after cesarean section. Nursing points include：recognition and first aid for occult postpartum haemorrhage；precise management of blood transfusion and volume resuscitation；objective-oriented temperature management strategy；postoperative observation and care for abdominal packing；provision of breastfeeding support in case of separation of mother and child；comprehensive psychological nursing support throughout all stages. Following active treatment and nursing interventions，the patient was discharged 10 d after surgery.

Key words: Vaginal Delivery after Cesarean Section, Broad Ligament Hematoma, Abdominal Packing, Postpartum Hemorrhage, Obstetrical Nursing

摘要：

总结1例剖宫产术后再次妊娠阴道分娩产妇因阔韧带血肿引发失血性休克的护理经验。护理要点：隐匿性产后出血的识别与急救；精准输血管理与容量复苏；实施目标导向的体温管理策略；腹腔填塞术后的观察与护理；母婴分离时的母乳喂养支持；全周期、分阶段的心理护理。经过积极的治疗与护理，患者术后10 d康复出院。

关键词: 剖宫产术后阴道分娩, 阔韧带血肿, 腹腔填塞, 产后出血, 产科护理

XU Xiaopei, LI Qiufang, HU Xiaoli. Nursing care of a parturient with broad ligament hematoma complicated with hemorrhagic shock in vaginal delivery[J]. Chinese Journal of Nursing, 2025, 60(8): 968-971.

徐晓佩, 李秋芳, 胡小黎. 1例阴道分娩产妇阔韧带血肿并发失血性休克的护理[J]. 中华护理杂志, 2025, 60(8): 968-971.

References 17

[1]	陈红晓, 田秀芳. 剖宫产术后再次妊娠阴道试产与选择性重复剖宫产母婴安全性的Meta分析[J]. 国际妇产科学杂志, 2017, 44(4):430-435.
	Chen HX, Tian XF. The safety of maternal and perinatal of trial of labor after previous cesarean delivery versus elective repeat cesarean delivery:a meta-analysis[J]. J Int Obstet Gynecol, 2017, 44(4):430-435.
[2]	中华医学会妇产科学分会产科学组. 剖宫产术后再次妊娠阴道分娩管理的专家共识(2016)[J]. 中华妇产科杂志, 2016, 51(8):561-564.
	Obstetrics Subgroup,Chinese Society of Obstetrics and Gyne-cology,Chinese Medical Association. Consensus on the manage-ment of vaginal delivery after cesarean(2016)[J]. Chin J Obstet Gynecol, 2016, 51(8):561-564.
[3]	王赛凤, 俞舒舒, 苏晓涵, 等. 剖宫产术并发血肿14例诊治体会[J]. 中国计划生育和妇产科, 2023, 15(7):103-107.
	Wang SF, Yu SS, Su XH, et al. Diagnosis and treatment of 14 cases of cesarean section complicated with hematoma[J]. Chin J Fam Plan Gynecotokology, 2023, 15(7):103-107.
[4]	Edmonds DK. Dewhurst’s textbook of obstetrics & gynaecology[M]. 6th ed. London: Blackwell Science, 1999,327.
[5]	陈璐, 周微笑, 贺晶. 软产道裂伤致隐匿性产后出血的早期识别及处理[J]. 中国实用妇科与产科杂志, 2022, 38(8):784-787.
	Chen L, Zhou WX, He J. Early identification and management of occult postpartum hemorrhage caused by genital tract laceration[J]. China Ind Econ, 2022, 38(8):784-787.
[6]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 产后出血预防与处理指南(2023)[J]. 中华妇产科杂志, 2023, 58(6):401-409.
	Obstetrics Subgroup, Chinese Society of Obstetrics and Gyne-cology, Chinese Medical Association;Chinese Society of Peri-natal Medicine, Chinese Medical Association. Guidelines for prevention and treatment of postpartum hemorrhage(2023)[J]. Chin J Obstet Gynecol, 2023, 58(6):401-409.
[7]	吉柳, 武文慧, 郝敏, 等. 长期使用低分子肝素的妊娠期妇女全程化药学服务模式构建与实践[J]. 中国医院药学杂志, 2023, 43(14):1619-1623. DOI
	Ji L, Wu WH, Hao M, et al. Full-course pharmaceutical care for pregnant women who use low molecular weight heparin for a long time[J]. Chin J Hosp Pharm, 2023, 43(14):1619-1623. DOI
[8]	李霞林, 贺芳. 严重产后出血器官功能保护策略[J]. 中国实用妇科与产科杂志, 2024, 40(4):406-409.
	Li XL, He F. Organ function protection strategies in severe postpartum hemorrhage[J]. Chin J Pract Gynecol Obstet, 2024, 40(4):406-409.
[9]	中华医学会围产医学分会, 中国输血协会临床输血管理学专业委员会. 产科输血治疗专家共识[J]. 中华围产医学杂志, 2023, 26(1):4-10.
	Society of Perinatal Medicine,Chinese Medical Association; Clinical Blood Transfusion Management Committee of Chinese Blood Transfusion Association. Expert consensus on blood transfusion in obstetrics[J]. Chin J Perinat Med, 2023, 26(1):4-10.
[10]	丁幼芽, 王钰炜, 闫丹萍, 等. 大剂量输血程序改进及在失血性休克患者中的应用[J]. 中华护理杂志, 2023, 58(21):2604-2609. DOI URL
	Ding YY, Wang YW, Yan DP, et al. Improvement of high dose blood transfusion procedure and its application in the treatment of patients with traumatic hemorrhagic shock[J]. Chin J Nurs, 2023, 58(21):2604-2609. DOI URL
[11]	张文波, 王革非, 李幼生, 等. 腹腔填塞在损伤控制外科中的应用[J]. 医学研究生学报, 2009, 22(6):655-660.
	Zhang WB, Wang GF, Li YS, et al. Application of abdominal packing in damage control surgery[J]. J Med Postgrad, 2009, 22(6):655-660.
[12]	李欣, 刘先韶, 李先锋. 剖宫产术后巨大阔韧带合并腹膜后血肿3例的临床处置[J]. 热带医学杂志, 2018, 18(9):1196-1198.
	Li X, Liu XS, Li XF. 3 cases of giant broad ligament with retroperitoneal hematoma after cesarean section and related literature review[J]. J Trop Med, 2018, 18(9):1196-1198.
[13]	邓永芳, 贺芳, 符白玲, 等. 促进母婴分离产妇母乳采集的循证实践[J]. 中华护理杂志, 2020, 55(1):22-27. DOI URL
	Deng YF, He F, Fu BL, et al. Evidence-based practice to promote breast milk expression among postpartum women with neonatal-maternal separation[J]. Chin J Nurs, 2020, 55(1):22-27. DOI URL
[14]	王姝媛, 马影蕊, 汪柏宇, 等. 穴位按摩促进产妇乳汁分泌的证据总结[J]. 护理学杂志, 2023, 38(21):11-15.
	Wang SY, Ma YR, Wang BY, et al. Evidence summary of acu-point massage promoting milk secretion in puerpera[J]. J Nurs Sci, 2023, 38(21):11-15.
[15]	岑慧萍, 李信群, 夏佳芬. 王不留行籽耳穴压豆对产妇泌乳Ⅱ期启动时间的影响研究[J]. 护理与康复, 2020, 19(11):75-76.
	Cen HP, Li XQ, Xia JF. Study on the effect of pressing beans at seed ear point of vaccaria seed on the start-up time of second lactation period of parturient[J]. J Nurs Rehabil, 2020, 19(11):75-76.
[16]	Hatch R, Young D, Barber V, et al. Anxiety,depression and post traumatic stress disorder after critical illness:a UK-wide prospective cohort study[J]. Crit Care, 2018, 22(1):310.
[17]	沙利娟, 张爱霞, 樊雪梅, 等. 产妇产后抑郁非药物干预的最佳证据总结[J]. 中华护理杂志, 2022, 57(24):2977-2984. DOI URL
	Sha LJ, Zhang AX, Fan XM, et al. Evidence summary of non-pharmacological interventions for maternal postpartum depression[J]. Chin J Nurs, 2022, 57(24):2977-2984. DOI URL