Hematoma after giving birth. Postpartum Vulvar Hematoma: A Rare but Serious Complication of Childbirth

20.08.202306.07.2023 by alexxlab

What are the causes and risk factors for postpartum vulvar hematoma. How is postpartum vulvar hematoma diagnosed and treated. Can postpartum vulvar hematoma lead to maternal near miss. What are the potential complications of untreated vulvar hematoma after childbirth.

Содержание

Understanding Postpartum Vulvar Hematoma: A Rare Complication

Postpartum vulvar hematoma is an uncommon but potentially serious complication that can occur following childbirth. It involves the collection of blood in the soft tissues of the vulva, often due to trauma or injury to blood vessels in the area. While rare, vulvar hematomas can lead to significant maternal morbidity and even mortality if not promptly recognized and properly managed.

What Exactly is a Vulvar Hematoma?

A vulvar hematoma is defined as an accumulation of blood within the soft tissues of the vulva. The vulva consists primarily of smooth muscle and loose connective tissue, with blood supply from branches of the pudendal artery. During pregnancy, the vulvar vasculature often develops varicosities due to increased venous pressure from the growing uterus. Damage to the labial branches of the internal pudendal artery in this vascular network can easily initiate hematoma formation.

Causes and Risk Factors for Postpartum Vulvar Hematoma

Several factors can contribute to the development of a postpartum vulvar hematoma:

Trauma during vaginal delivery
Instrumental deliveries (forceps or vacuum)
Prolonged second stage of labor
Varicose veins in the vulvar area
Coagulation disorders
Precipitous labor

Multiparous women may be at higher risk due to the increased likelihood of vulvar varicosities. Additionally, home deliveries without proper medical supervision can increase the risk of undetected vulvar trauma leading to hematoma formation.

Clinical Presentation and Diagnosis of Vulvar Hematoma

Recognizing the signs and symptoms of a postpartum vulvar hematoma is crucial for timely intervention. Common presentations include:

Severe vulvar pain and swelling
Visible bruising or discoloration of the vulva
Difficulty urinating
Sensation of pressure in the perineal area
Vaginal bleeding (if the hematoma ruptures)

Diagnosis is typically made through physical examination, revealing a tense, painful swelling of the vulva. In some cases, imaging studies such as ultrasound may be used to confirm the diagnosis and assess the extent of the hematoma.

Treatment Approaches for Postpartum Vulvar Hematoma

The management of vulvar hematomas depends on their size, rate of expansion, and associated symptoms. Treatment options include:

Conservative Management

For small, stable hematomas (< 5 cm), conservative treatment may be appropriate. This involves:

Application of ice packs to reduce swelling
Pain management with analgesics
Close monitoring for expansion or signs of infection

Surgical Intervention

Larger hematomas or those causing significant symptoms often require surgical management:

Incision and drainage of the hematoma
Identification and ligation of bleeding vessels
Placement of drainage tubes if necessary
Closure of dead space to prevent reaccumulation

In severe cases, blood transfusion may be necessary to address associated anemia.

Potential Complications of Untreated Vulvar Hematoma

If left untreated or inadequately managed, postpartum vulvar hematomas can lead to serious complications:

Severe anemia due to blood loss
Infection and abscess formation
Necrotizing fasciitis
Urinary retention
Chronic pain and dyspareunia
Maternal near miss or even maternal death in extreme cases

Prompt recognition and appropriate management are essential to prevent these potentially life-threatening complications.

Vulvar Hematoma as a Cause of Maternal Near Miss

The concept of maternal near miss (MNM) refers to cases where women nearly die but survive complications related to pregnancy or childbirth. Postpartum vulvar hematoma, though rare, can potentially lead to MNM through several mechanisms:

Significant blood loss leading to hemorrhagic shock
Severe anemia requiring urgent blood transfusion
Sepsis if the hematoma becomes infected
Organ dysfunction due to prolonged shock or severe anemia

The case report presented in the original article highlights how a neglected vulvar hematoma can escalate to a life-threatening situation, underscoring the importance of timely intervention and proper management.

Prevention and Early Detection of Postpartum Vulvar Hematoma

While not all cases of vulvar hematoma can be prevented, certain measures can reduce the risk and promote early detection:

Careful perineal support during the second stage of labor
Judicious use of episiotomy when indicated
Proper training of birth attendants in identifying vulvar trauma
Thorough postpartum examination of the vulva and perineum
Patient education on signs and symptoms to watch for after discharge

Healthcare providers should maintain a high index of suspicion for vulvar hematoma in women presenting with perineal pain or swelling after childbirth, especially in cases of home deliveries or precipitous labor.

The Role of Antenatal Care in Preventing Complications

Adequate antenatal care plays a crucial role in identifying risk factors and ensuring appropriate delivery planning. In the case presented, the patient had received antenatal care at a local health center. However, the rapid progression of labor led to an unplanned home delivery, highlighting the importance of:

Educating pregnant women about the signs of labor and when to seek medical care
Developing birth preparedness plans, especially for women in rural areas
Strengthening referral systems for timely transfer to higher-level facilities when needed

Improving access to skilled birth attendance and emergency obstetric care can significantly reduce the risk of complications like vulvar hematoma and their potential progression to maternal near miss scenarios.

The Importance of Proper Postpartum Care

The case report emphasizes the critical nature of thorough postpartum assessment and follow-up. Even after initial management of a vulvar hematoma, close monitoring is essential to detect potential complications such as:

Recurrence or expansion of the hematoma
Development of infection
Delayed hemorrhage
Persistent anemia

Healthcare providers should educate new mothers about normal postpartum recovery and signs that warrant immediate medical attention. This includes information about perineal care, normal vs. abnormal bleeding patterns, and when to seek help for pain or swelling in the vulvar area.

Addressing Challenges in Low-Resource Settings

The case presented highlights several challenges faced in managing obstetric complications in low-resource settings:

Limited access to skilled birth attendants
Delays in seeking care due to geographic or socioeconomic barriers
Lack of blood products for transfusion at lower-level facilities
Need for referral to higher-level facilities for comprehensive care

Addressing these challenges requires a multifaceted approach:

Strengthening community-based maternal health programs
Improving emergency transport systems for obstetric referrals
Enhancing the capacity of rural health facilities to manage obstetric emergencies
Implementing effective blood banking and distribution systems

By focusing on these areas, healthcare systems can better respond to rare but serious complications like postpartum vulvar hematoma, reducing the risk of maternal near miss and mortality.

The Need for Continued Research and Education

While postpartum vulvar hematoma is a rare complication, its potential severity underscores the need for ongoing research and education in this area. Key areas for focus include:

Improving risk assessment tools for predicting vulvar hematoma
Developing standardized management protocols for different hematoma sizes and presentations
Enhancing training for healthcare providers in early recognition and proper management
Conducting larger epidemiological studies to better understand incidence and risk factors in different populations

By advancing knowledge in these areas, the medical community can work towards reducing the incidence of vulvar hematoma and improving outcomes when it does occur.

Long-term Follow-up and Psychological Support

The experience of a severe postpartum complication like vulvar hematoma can have lasting physical and psychological effects on new mothers. Comprehensive care should include:

Long-term follow-up to assess for chronic pain or other persisting symptoms
Evaluation of pelvic floor function and referral for physiotherapy if needed
Screening for postpartum depression and anxiety, which may be exacerbated by traumatic birth experiences
Provision of counseling and support services to help women process their experiences
Education about potential implications for future pregnancies and deliveries

By addressing both the physical and emotional aspects of recovery, healthcare providers can support women in achieving optimal health and well-being after experiencing this rare but significant complication.

Implications for Future Pregnancies

Women who have experienced a postpartum vulvar hematoma may have concerns about future pregnancies and deliveries. Healthcare providers should address these concerns by:

Discussing the likelihood of recurrence in subsequent pregnancies
Developing individualized care plans for future antenatal care and delivery
Considering the potential need for elective cesarean section in cases of severe previous hematoma
Providing preconception counseling to optimize health before future pregnancies

By proactively addressing these issues, healthcare providers can help women make informed decisions about future reproductive choices and ensure appropriate care in subsequent pregnancies.

The Role of Interdisciplinary Collaboration

Effective management of postpartum vulvar hematoma often requires collaboration between multiple specialties. This may include:

Obstetricians and gynecologists for primary management
Anesthesiologists for pain management and surgical support
Hematologists for management of severe anemia or coagulation disorders
Radiologists for imaging studies when needed
Plastic surgeons for complex reconstructive procedures in severe cases

Fostering strong interdisciplinary teams and clear communication channels can enhance the quality of care provided to women experiencing this complication.

Improving Systems for Maternal Near Miss Surveillance

The case of vulvar hematoma leading to maternal near miss highlights the importance of robust surveillance systems for severe maternal morbidity. Such systems can:

Help identify patterns and risk factors for rare complications
Guide the allocation of resources for maternal health services
Inform the development of targeted interventions to reduce maternal morbidity and mortality
Provide valuable data for research and quality improvement initiatives

By implementing and maintaining comprehensive maternal near miss surveillance, healthcare systems can better track and respond to serious complications like postpartum vulvar hematoma, ultimately improving maternal health outcomes.

Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature

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J Med Case Rep
v.16; 2022
PMC8883656

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J Med Case Rep. 2022; 16: 85.

Published online 2022 Feb 28. doi: 10.1186/s13256-022-03281-2

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Data Availability Statement

Background

Postpartum spontaneous vulvar hematoma is a rare complication of childbirth that can potentially cause maternal death if not managed properly and in a timely manner.

Case summary

We present the case of maternal near miss secondary to postpartum hemorrhage secondary to vulvar hematoma after home delivery in a 28-year-old para IV mother from rural Ethiopia. The case was surgically managed under spinal analgesia. The mother and her newborn were discharged on the fourth postprocedure day.

Conclusion

Neglected and inappropriately managed postpartum vulvar hematoma can cause significant maternal morbidity; therefore, timely surgical exploration, ligation of bleeding vessels, and obliteration of dead space can avert severe maternal complications

Keywords: Vulvar hematoma, Postpartum, Severe anemia, Maternal near miss

According to the World Health Organization (WHO), maternal near miss (MNM) is defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy” [1]. In Ethiopia, for every woman who dies from pregnancy-related causes, 12–21 others experience maternal near miss (MNM) [1–3]. One of the causes of MNM is postpartum hemorrhage (PPH) [1, 4, 5]. The major causes of PPH are uterine atony, genital tract laceration, retained tissues (placenta and membranes), and coagulopathy [4, 5]. Vulvar hematoma is among genital tract traumas that cause PPH [5, 6].

A vulvar hematoma is a collection of blood in the vulva [6]. The vulva is soft tissue mainly composed of smooth muscle and loose connective tissue and is supplied by branches of the pudendal artery [7, 8]. The venous drainage is provided by labial veins, and labial veins drain into the external and internal pudendal veins [8, 9]. This vulvar vasculature commonly develops varicosities during pregnancy, especially in parous women, due to increased venous pressure created by the increasing weight of the uterus [8]. Damage to labial branches of the internal pudendal artery in this vascular network easily initiates hematoma development [7–9].

Postpartum vulvar hematomas cause maternal morbidities such as anemia, postpartum hemorrhage, superinfection, necrotizing fasciitis, prolonged hospitalization, and need for transfusion [5–7]. Here we present, a case of postpartum vulvar hematoma as the cause of MNM.

This is a 28-year-old para IV mother from rural Ethiopia who gave birth to an alive female neonate weighing 3000 g at home 24 hours before presentation. She did not remember her last normal menstrual period (LNMP) but claimed to be amenorrheic for 9 months. She had antenatal care (ANC) at a nearby health center where she had routine investigations and care during pregnancy. During the last antenatal visit, she was told to come to the health center when she feels labor pains. However, her labor advanced within 6 hours of the onset of labor pain. She gave birth normally at home with the assistance of traditional birth attendants. The mother reported that there was neither difficulty with delivery of the placenta nor excessive bleeding during and after delivery. She noticed gradual swelling of her right vulva that was associated with vulvar pain. Due to the worsening of these complaints, the family took her to nearby hospital. At this hospital, evacuation of vulvar hematoma (6 cm × 8 cm) was done. The managing team evacuated 500 ml of hematoma and referred the patient to Wollega University Referral Hospital (WURH) for blood transfusion.

Upon arrival to WURH, the patient was re-evaluated by the charge resident physician and consultant gynecologist, and obstetrician. The mother reported vaginal bleeding from the vulva on her way to WURH, significant swelling of the vulva, and vulvar pain. She had difficulty with micturition. She also complained of palpitation, easy fatigability, vertigo, and headache. The patient had no history of hypertension, diabetes mellitus, or bleeding tendency.

On examination, she was acutely sick-looking. Her vital signs were blood pressure (BP) 90/60 mmHg, pulse rate (PR) 136 beats per minute, respiratory rate (RR) 22 breaths per minute, and temperature 37.1 °C. She had dry buccal mucosa and pale conjunctivae. Lymph glandular system, chest, and cardiovascular system were normal. Abdominal examination showed a 20-week-sized uterus that was well contracted and nontender, and the bladder was distended. There were no signs of fluid collection or organomegaly. On genital examination, there was a 12 × 20 cm right-sided vulvar mass extending to the mons pubis and posteriorly to the right buttock (Fig. ). The mass was tender and fluctuant. There were two stitches applied to it. However, there was bleeding from this site. There was no active vaginal bleeding or vaginal and cervical tear. She exhibited palmar pallor. On neurologic examination, she was oriented to time, person, and place. She had normal reflexes and no neurologic deficits. With the final diagnosis of severe anemia secondary to postpartum hemorrhage secondary to a vulvar hematoma, she was admitted to the obstetric ward. At admission, she was investigated and the results were as indicated in Table .

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Postpartum spontaneous vulvar hematoma managed at Wollega University Referral Hospital, Western Ethiopia, 2021

Table 1

Summary of laboratory investigations of the case of postpartum spontaneous vulvar hematoma managed at Wollega University Referral Hospital, Western Ethiopia, 2021

Time of investigations	Laboratory tests	Results
At admission	CBC count	WBC count 1760 cells/μl; RBC count 1. 1 million cells/μL; hematocrit 10.3%^a; platelet count 189,000 cells/μl; MCV 92.2 fL; MCH 30.6 picograms(pg)
	Urinalysis	Nonrevealing
	RBG	145 mg/dl
	Blood group	B+
	Abdominopelvic ultrasound	Empty uterus, no peritoneal collection
	VDRL	Nonreactive
	HBsAg	Nonreactive
After procedure	CBC count	WBC count 1971 cells/μl; RBC count 1. 4 million cells/μl; platelet count 177,000 cells/μl; MCV 92.1 fL; MCH 30.7 picograms(pg)
		Hematocrit 12.9%^b
		Hematocrit 17.2%^c

Open in a separate window

CBC complete blood count, WBC white blood cell, RBC red blood cell, VDRL Venereal Disease Research Laboratory, HBsAg hepatitis B surface antigen, RBG random blood glucose, MCV mean corpuscular volume, MCH mean corpuscular hemoglobin

^aAt admission

^bAfter the first transfusion

^cAfter the second transfusion

The patient was prepared and taken to the operation room. Under spinal analgesia, through a previous incision made at referring hospital, about 700 ml of clotted blood was evacuated from vulvar hematoma. The actively bleeding vessels were identified and ligated. Then, the wound was sutured in three layers. The site was observed for bleeding and vulvar swelling. A hemostatic gauze was used for further compression and removed after 12 hours. The patient was transferred to ward where she was transfused with two units of compatible blood. On the fourth postprocedure day, the patient was discharged with ferrous sulfate and appropriate advice on vulvar care.

This is the case of maternal near miss in rural Ethiopia. The major causes of maternal near-miss events are obstetric hemorrhages, hypertensive disorders of pregnancy, difficult labor and delivery, sepsis, complications of abortion, and uterine rupture [1, 5]. This patient presented with postpartum hemorrhage (PPH) secondary to spontaneous vulvar hematoma. It is an unusual cause of PPH [5, 6]. The other causes of PPH such as uterine atony retained tissue, coagulopathy, and genital tract laceration were excluded from patient history, physical examination, and laboratory investigation. A huge postpartum vulvar hematoma explained the patient’s condition. The hematoma was severe enough to cause maternal shock and severe anemia. This patient could have died had she not been aggressively managed with intravenous fluid, blood transfusion, and surgical intervention.

Postpartum vulvar hematomas are rare events in modern obstetrics. Their magnitude varies from 1 per 300 to 1 per 15,000 deliveries. It can be classified into obstetric and non-obstetric vulvar hematomas [6, 8, 10, 11]. Postpartum vulvar hematomas most frequently result from genital tract laceration [8] or improper hemostasis during the repair of perineal tears or an episiotomy wound. Failure to take precautions while suturing the apex of the episiotomy may result in a large vulvovaginal hematoma due to the distensible nature of the tissue [12, 13].

Postpartum spontaneous vulvar hematomas are rare events. They result from injury to blood vessels in the absence of laceration or incision of the surrounding tissue (such as pseudoaneurysm and traumatic arteriovenous fistula) [10, 13]. They usually follow precipitate labor, macrosomic babies, prolonged second stage of labor, hypertensive disorders of pregnancy, coagulopathy, or vulvar varicosities [2, 10, 11, 14]. In our case, the total duration of labor was only 6 hours, which might have been the triggering factor. It occurred spontaneously after home vaginal delivery. It is observed that most spontaneous vulvar hematomas are right-sided vulvar hematomas [11] as in our case. This may be due to dextrorotation of the uterus, which might cause vulvar varicosities.

The pathogenesis of vulvar hematomas is due to iatrogenic injury to blood vessels and/or spontaneous rupture resulting in various symptoms such as vulvar swelling, vulvar pain, and urologic symptoms [6, 8, 10, 15]. Our patient presented with vulvar swelling, vulvar pain, and difficulty with urination. As bleeding into the vulva is largely restricted only by the Colles fascia and the urogenital diaphragm, a hematoma in this area is visible as tender fluctuant mass [15] as in our case.

Vulvar hematomas may develop within hours after delivery or be initially misdiagnosed as vulva swelling or edema until the delayed formation of the hematoma [8, 14]. Early recognition is paramount in reducing the associated morbidity, improving patient outcomes, and shortening the length of hospital stay. Delay in recognition and management may result in adverse consequences and increase maternal morbidity [7, 11, 14] as in our case.

The management of vulvar hematomas depends on the size of the hematoma, hemodynamic stability of the patient, availability of medical resources, and duration of the hematoma [9, 10, 14, 16]. Smaller and chronic vulvar hematomas can be conservatively managed [9] including the use of sitz baths, ice packs, empiric antibiotics, pain medication, and/or blood transfusion [12, 14]. However, large and rapidly expanding hematomas, as in this case, are managed by surgical techniques [9, 11]. The surgical management can be surgical exploration or selective arterial embolization [9, 10]. The surgical exploration consists of incision and drainage of the hematoma, ligation of the bleeding vessels, and packing or placement of drainage tube [9–11]. Our patient was managed by a similar approach. However, the primary treating hospital did not place a vaginal pack or drainage tube. As a result, the patient was having ongoing active bleeding from the incision site on the way to the referral hospital. This made the patient develop a recurrent huge hematoma. Therefore, optimal management of vulvar hematomas includes surgical exploration, ligation of bleeding vessels, obliteration of the dead space and placing pack in the vagina, placing drainage tube, or applying pressure over it [9, 10, 14]. The surgical exploration also prevents pressure necrosis of the surrounding tissue and decreases the risk of infection and necrotizing fasciitis [6, 8]. Sometimes, however, a surgical repair may fail or a recurrent hematoma can be formed, as in our case. In such cases, selective arterial embolization is the treatment of choice [10, 17].

We thank the patient for allowing the publication of this case report.

Authors’ details

TT is Associate Professor of obstetrics and gynecology, Institute of Health Sciences, Wollega University; AW is Assistant Professor of obstetrics and gynecology, Institute of Health Sciences, Wollega University; AL is medical doctor and first-year resident of obstetrics and gynecology, Institute of Health Sciences, Wollega University; RO is lecturer in the department of public health, Institute of Health Sciences, Wollega University.

ANC	Antenatal care
CBC	Complete blood count
HBsAg	Hepatitis B surface antigen
LNMP	Last normal menstrual period
MCH	Mean corpuscular hemoglobin
MCV	Mean corpuscular volume
MNM	Maternal near miss
PPH	Postpartum hemorrhage
RBC	Red blood cell
RBG	Random blood glucose
VDRL	Venereal Disease Research Laboratory
WBC	White blood cell
WUR	Wollega University Referral Hospital

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. All authors read and approved the final manuscript.

No funding source

The datasets used during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Wollega University Referral Hospital has approved the publication of this case. The study protocol is performed per the relevant guidelines.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors report no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Medically reviewed by Cynthia Cobb, DNP, APRN, WHNP-BC, FAANP — By Donna Christiano — Updated on April 24, 2018

What is a vaginal hematoma?

A vaginal hematoma is a collection of blood that pools in the soft tissues of the vagina or vulva, which is the outer part of the vagina. It happens when nearby blood vessels break, usually due to an injury. Blood from these broken vessels can leak into surrounding tissues. You can think of it as a kind of deep bruise.

Keep reading to learn more about the symptoms of a vaginal hematoma and what kind of treatments are available.

In many cases, a small vaginal hematoma won’t cause any symptoms. Larger hematomas may cause:

Pain and swelling. You may be able to feel or see a mass covered by purple- or blue-colored skin, similar to a bruise.
Painful or difficult urination. If the mass puts pressure on your urethra or blocks your vaginal opening, you might have hard time urinating. This pressure can also make it painful.
Bulging tissue. Very large hematomas sometimes extend outside of the vagina.

Vaginal hematomas, like all hematomas, are usually the result of an injury. The vagina contains a lot of blood vessels, especially in comparison to other areas of the body.

Several things can injure the vagina, including:

falling
vigorous sexual intercourse
high-impact sports

This type of hematoma can also happen during vaginal childbirth, either due to pressure from pushing or injuries from medical instruments, including forceps. Having an episiotomy can also cause a vaginal hematoma. This refers to a surgical cut near the vaginal opening to make it easier for a baby to pass through it. Vaginal hematomas caused by childbirth may not show up until a day or two after giving birth.

To diagnose a vaginal hematoma, your doctor will start by doing a basic exam of your vulva and vagina to check for any visible signs of a hematoma. Depending on what they find during the exam, your doctor might also order an ultrasound or CT scan to see how big the hematoma is and whether it’s growing.

Vaginal hematomas can sometimes lead to dangerous bleeding, so it’s a good idea to check in with your doctor, even if the hematoma seems minor.

There are several treatment options for vaginal hematomas, depending on how large they are and whether they’re causing symptoms.

A small hematoma, usually under 5 centimeters in diameter, is usually manageable with over-the-counter pain relievers. You can also apply a cold compress to the area to reduce swelling.

If you have a larger vaginal hematoma, your doctor may need to surgically drain it. To do this, they’ll start by numbing the area with a local anesthetic. Next, they’ll make a small incision in the hematoma and use a small tube to drain the pooled blood. Once the blood is gone, they’ll stitch up the area. You might also be given an antibiotic to prevent an infection.

Very large hematomas, or hematomas located deep in the vagina, may require heavier sedation and more extensive surgery.

Vaginal hematomas are relatively rare. When they do happen, it’s usually the result of an injury or childbirth. The vagina is rich in blood vessels, so any kind of trauma in this area can cause a hematoma. While small ones often heal on their own, larger ones may need to be drained by your doctor. Regardless of the size, it’s best to make an appointment with your doctor to make sure you don’t have any internal bleeding.

Last medically reviewed on April 24, 2018

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Postpartum hemorrhage. (2017).
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Puerperal genital haematomas. (n.d.).
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Roman AS, et al. (2017). Management of hematomas incurred as a result of obstetrical delivery.
uptodate.com/contents/management-of-hematomas-incurred-as-a-result-of-obstetrical-delivery

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Medically reviewed by Cynthia Cobb, DNP, APRN, WHNP-BC, FAANP — By Donna Christiano — Updated on April 24, 2018

Medical Bulletin of the North Caucasus :: Scientific and practical journal

Medical Bulletin
of the North Caucasus

Scientific and practical journal

Registered with the Federal Service

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and protection of cultural heritage

PI No. ФС77-26521 dated December 7, 2006
ISSN
2073-8137

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The journal is included in the List of leading peer-reviewed scientific journals and publications in which the results of dissertations for the degree of candidate and doctor of science should be published (decision of the Presidium of the Higher Attestation Commission of the Ministry of Education and Science of the Russian Federation No. 6/6, February 2010).

The journal is included in the Abstract Journal and Databases of VINITI RAS and registered in the Scientific Electronic Library in the database of the Russian Science Citation Index on the basis of sublicense agreement No. 07-04 / 09-14 dated March 25, 2009.

The journal is indexed by: SCOPUS database, Ulrich’s International Periodicals Directory.

EBSCO

https://doi.org/10.14300/mnnc.2014.09040

[Original research] [OB/GYN]
Novikova Vladislava Alexandrovna; Aseeva Evgenia; Corner Natalia; Khorolsky Vadim Alexandrovich; Filina Karina; Kazibekova F ;

Bleeding in the postpartum period is a threat to a woman’s life. Vaginal hematomas measuring 10.1 ± 3.6 cm can be asymptomatic at the beginning of their formation, which may cause an underestimation of total blood loss in women with postpartum hemorrhage due to other competing causes. The use of labor anesthesia makes it difficult to timely diagnose postpartum hematomas of the vagina, perineum, or hemostasis defects in the area of suturing after episiotomy or suturing of soft tissue tears in the birth canal. In the present study, 120 women with varicose veins of the lower extremities were examined, mean age 24.2±5.12 years, gestational age at delivery 38.20±1.09weeks. For the purpose of timely diagnosis of postpartum hematomas of the vagina, perineum or hemostasis defects in the area of suturing after episiotomy or suturing of soft tissue ruptures of the birth canal, 2 hours after delivery, women underwent a transperineal ultrasound examination of the vagina, perineum using a PHILLIPS HD-11 ultrasound scanner. Vaginal hematoma was detected in 31 (25.8%) women, and only 10 (8%) had a violation of the integrity of the mucous membrane, in 21 (17%) there was no violation of the integrity of the vaginal mucosa. In no case did the woman present any complaints characteristic of hematoma formation.

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References:
1. Aylamazyan E. K., Kulakov V. I., Radzinskiy V. E., Savelyeva G. M. Obstetrics: National Guide. M.: “GEOTAR-Media”; 2007. 1200 p.
2. Obstetrics and gynecology. Differential diagnostics from A to Z / Ed. Tony Hollingworth. M.: “GEOTAR-Media”; 2010. 400 p.
3. Artyimuk N. V. Varicose veins of the small pelvis in women. Russian journal of obstetrician-gynecologist. 2007;6:74-77.
4. Babadzhanova G. S., Habibullaeva M. F. Diagnostics and treatment of small pelvis vein disease in pregnant women. woman’s health. 2009;4(40):28-30.
5. Bogachev V. Yu. Small pelvis vein disease. Consilium medicum. 2006;1(1):20-23.
6. Ilyina I. Yu. Varicose veins of the small pelvis in women as a manifestation of connective tissue dysplasia. Russian journal of obstetrician-gynecologist. 2009;2:39-42.
7. Clinical recommendations. Obstetrics and Gynecology. – 4th edition, revised / Ed. V.N. Serov, G.T. Sukhikh. M.: “GEOTAR-Media”; 2014. P. 499-514.
8. Mozes V. G. Varicose veins of the small pelvis in women through various life stages: Abstract, Thesis of Cand. of Med. Sc. Tomsk; 2006.39p.
9. Sukhikh G. T., Serov V. N., Savelieva G. M. et al. Prevention and therapy of massive blood loss in obstetrics. Medical technology FS No. 2010/141, of 29/04/2010.
10. Daliakopoulos S. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report. Journal of Medical Case Reports. 2008;2:162.
11. WHO recommendations for prevention and treatment of postpartum hemorrage, 2012.

Key words: postpartum hemorrhage, massive blood loss, vaginal hematomas

Founders:
Stavropol State Medical Academy
State Research Institute of Balneology
Pyatigorsk State Pharmaceutical Academy

Consequences of childbirth cephalohematoma in the future – important information for parents – Dobrobut Clinic

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Publication date: 2020-01-22

Cephalohematoma in newborns on the head – symptoms, treatment

A cephalohematoma is a birth injury characterized by the formation of a hematoma. Pathology is diagnosed in 3% of babies, regardless of gender. Cephalhematoma in newborns on the head can be accompanied by various complications: deformation of the bones of the skull, suppuration, anemia and jaundice. Formations come in various sizes and depend primarily on the volume of accumulated blood. Due to the failure of the hemostasis system in the baby’s body, blood can accumulate for several days after childbirth, contributing to an increase in the size of the hematoma.

Causes of cephalohematoma during childbirth:

large fruit;
rapid delivery;
abnormal position of the fetus;
premature or prolonged labor;
cord entanglement;
discrepancy between the size of the pelvis of the mother and the head of the fetus;
pathology of intrauterine development;
use during childbirth forceps.

Classification of cephalohematoma

As noted above, external cephalohematoma is a hemorrhage between the periosteum and the surface of the bones of the skull, which disappears by the end of the second month of a baby’s life.

Depending on the location, the hemorrhage can be frontal, occipital, parietal and temporal. According to the severity, cephalohematoma of I degree (hematoma volume 3-4 cm), II (4-9 cm) and III (hemorrhage more than 9 cm) are distinguished. The consequences of a generic cephalohematoma in the future depend on the size of the formation and the general condition of the newborn. Given the localization of the hemorrhage, cephalohematoma can be left-sided, right-sided and bilateral. In some cases, the pathology is accompanied by concomitant injuries in the form of a fracture (crack) of the skull bones.

Signs of ossified cephalohematoma

A cephalohematoma occurs within a few hours after the baby is born. The next 2-3 days, the formation increases in size, after which a period of regression begins. Complete resorption of the hematoma occurs by the end of 8 weeks.

Main symptoms:

education has clear boundaries;
on day 2-3, the growth of the hematoma stops;
the color of the skin in the area of cephalohematoma is unchanged;
hematoma soft to the touch;
the general condition of the baby is unchanged.

On our website Dobrobut.com you can make an appointment with a specialist and get an answer to any question. The doctor will tell you about the main signs of ossified cephalohematoma and about the methods of treating the pathology.

Diagnosis

The diagnosis is made after a thorough examination of the baby. Differentiate cephalohematoma from cerebral hernia, birth tumor, coagulopathy, congenital mycoplasmosis and hemorrhage under the aponeurosis will help research: ultrasound, CT, neurosonography and craniogram.

Treatment of cephalohematoma in a child

Hemorrhage is treated by a neonatologist or pediatric surgeon. With a small hematoma, special treatment is not necessary. The baby is prescribed calcium and vitamin K preparations for 5-7 days. The course of therapy for uncomplicated pathology is 7–10 days. It will take at least a month to treat a cephalohematoma in a child with complications. A baby with such a pathology must be registered with a surgeon and a neurologist.

Neonatologists advise the use of Troxerutin to accelerate the healing of the mass. The gel is applied to the hematoma area twice a day. The drug increases vascular tone and prevents further penetration of blood.

In case of extensive hemorrhage (more than 9 cm in volume), the doctor will prescribe surgery. Puncture of cephalohematoma of the parietal bone is a safe procedure for the health of the baby, the duration of which takes no more than 10 minutes. The child’s skin at the site of hematoma formation is pierced with a special needle, the accumulated blood is sucked off, after which the puncture site is disinfected and a pressure bandage is applied. Surgical removal of cephalohematoma is indicated in the presence of purulent contents of the cavity, as well as in the III degree of development of the pathology.

Doctor’s recommendations after the puncture:

parents must strictly follow the specialist’s instructions;
in no case should you self-medicate;
protect the newborn’s head from injury;
use a cap one size larger;
closely monitor the general condition of the baby.

Consequences and prognosis

In most cases, the prognosis is favorable. Serious consequences occur in a small percentage of babies due to the displacement of brain structures under the pressure of a hematoma and the accumulation of blood under the periosteum.

Most severe consequences:

infection of the meninges;
anemia;
compression of the optic (auditory) nerves;
suppuration;
ossification of cephalohematoma with irreversible deformation of the skull bones.

If you have any questions, sign up for a consultation by phone or fill out the form on the website.

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Breastfeeding, its role in a child’s life

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