{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:10:39Z","timestamp":1793466639506,"version":"4.5.0"},"reference-count":6,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,10,27]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>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\u2009hours after admission, showed a large ill-defined collection with hyperdense areas of blood attenuation measuring ~8.0\u00d76.2\u00d712.2\u2009cm 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.<\/jats:p>","DOI":"10.1136\/bcr-2023-256677","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T13:10:45Z","timestamp":1702127445000},"page":"e256677","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Large supralevator haematoma: a dilemma in diagnosis and management"],"prefix":"10.1136","volume":"16","author":[{"given":"Nipasa","family":"Sarma","sequence":"first","affiliation":[{"name":"Junior Resident, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of higher education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shripad","family":"Hebbar","sequence":"additional","affiliation":[{"name":"Professor and Head, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of higher education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruthvika","family":"Kundoor","sequence":"additional","affiliation":[{"name":"Junior Resident, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of higher education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,9]]},"reference":[{"key":"2025082701380106000_16.12.e256677.1","unstructured":"Cunningham F , Leveno KJ , Bloom SL , et al . Obstetrical hemorrhage. In: Williams Obstetrics. 24th edition. 2014: 790."},{"key":"2025082701380106000_16.12.e256677.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17077\/2154-4751.1403","article-title":"Successful management of a supralevator intraperitoneal puerperal hematoma with angiographic embolization","volume":"9","author":"Fahimuddin","year":"2019","journal-title":"Proc Obstet Gynecol"},{"key":"2025082701380106000_16.12.e256677.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.crwh.2021.e00311","article-title":"Large concealed paravaginal hematoma: A case report of an occult postpartum heaemorrhage","volume":"30","author":"Stobie","year":"2021","journal-title":"Case Reports in Women\u2019s Health"},{"key":"2025082701380106000_16.12.e256677.4","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-225980","article-title":"Retziusspacehaematomaasararecauseofconcealedret- roperitoneal postpartum haemorrhage following spontaneous vaginal delivery","volume":"2018","author":"Acreman","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082701380106000_16.12.e256677.5","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1097\/AOG.0000000000000948","article-title":"Ultrasound-guided drainage of supralevator hematoma in a hemodynamically stable patient","volume":"126","author":"Mukhopadhyay","year":"2015","journal-title":"Obstet Gynecol"},{"key":"2025082701380106000_16.12.e256677.6","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1620\/tjem.249.135","article-title":"Establishing a treatment algorithm for puerperal genital hematoma based on the clinical findings","volume":"249","author":"Soeda","year":"2019","journal-title":"Tohoku J Exp Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256677","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:38:10Z","timestamp":1756283890000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":6,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,9]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bcr-2023-256677"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256677","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}