{
  "abstract": "We report a case of intra-abdominal hemorrhage associated with vascular injury in the recto-vaginal space and peritoneal injury in the Douglas pouch following vacuum-assisted delivery with an unsuccessful Kristeller maneuver. The patient was 41 years old, gravida 2, para 1. At 40 weeks gestation, labor was induced by administering oxytocin. Due to prolonged second stage of labor in breech presentation, vacuum-assisted delivery with the Kristeller maneuver was attempted in vain, followed by forceps delivery, resulting in the delivery of a female infant weighing 3,178 g. However, at two hours postpartum, the patient went into a state of shock, with a blood pressure of 59/41 mmHg and pulse rate of 98 beats/minute, and was transferred to our tertiary care center. Exploratory laparotomy revealed bleeding from peritoneal injury in the Douglas pouch, serosal injury of the rectum, and also from the vaginal venous plexus at the site of connective tissue injury in the recto-vaginal space. There were no other sources of bleeding, including no uterine rupture in the birth canal. We hypothesized that a shearing effect around the recto-vaginal space and the Douglas pouch, possibly generated by the forces associated with instrumental delivery and the Kristeller maneuver, may have contributed to the connective tissue injury in the retroperitoneal space and peritoneal injury in the Douglas pouch. Although no direct evidence of uterine or vaginal injury was found, it is important to recognize the potential for injuries to the retroperitoneal space and abdominal cavity when performing instrumental delivery along with the Kristeller maneuver.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, JPN."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tetsu Yamaguchi"
    },
    {
      "affs": [
        0
      ],
      "name": "Shunsuke Tamaru"
    },
    {
      "affs": [
        0
      ],
      "name": "Namba Akira"
    },
    {
      "affs": [
        0
      ],
      "name": "Takeshi Kajihara"
    },
    {
      "affs": [
        0
      ],
      "name": "Yoshimasa Kamei"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/50ek56k49ppyp.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116829",
  "fulltext_url": "https://europepmc.org/articles/PMC13695324",
  "id": "50ek56k49ppyp",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42927359",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2735|Maternal and fetal healthcare"
    ]
  ],
  "openalex": "W7214220801",
  "pdf_url": "https://europepmc.org/articles/PMC13695324?pdf=render",
  "pmcid": "PMC13695324",
  "pmid": "42927359",
  "published": "2026-09-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/50ek56k49ppyp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42927359",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42927359"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2735|Maternal and fetal healthcare",
      "subfield": "reproductive-child"
    }
  ],
  "title": "A Case of Intra-abdominal Hemorrhage Following a Failed Kristeller Maneuver With Vacuum-Assisted Delivery.",
  "title_text": "A Case of Intra-abdominal Hemorrhage Following a Failed Kristeller Maneuver With Vacuum-Assisted Delivery.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/50ek56k49ppyp",
  "venue": "Cureus",
  "versions": []
}