Skip to contentHematoma after giving birth. tag, and the SEO description of the article in the tag.Postpartum Spontaneous Vulvar Hematoma: A Rare but Serious Complication</h1><div class="post-date"><div class="entry-meta"> <span class="posted-on"><a href="https://elispot.biz/about-all/hematoma-after-giving-birth-postpartum-spontaneous-vulvar-hematoma-as-a-cause-of-maternal-near-miss-a-case-report-and-review-of-the-literature-5.html" rel="bookmark"><time class="entry-date published" datetime="2023-08-15T11:07:06+03:00">15.08.2023</time><time class="updated" datetime="2023-07-06T19:25:13+03:00">06.07.2023</time></a></span><span class="post_by"> by <span class="author vcard"><a class="url fn n" href="https://elispot.biz/author/alexxlab">alexxlab</a></span></span></div></div><div class="content post-excerpt entry-content clearfix"><blockquote><p>What is postpartum spontaneous vulvar hematoma? How can it lead to maternal near miss? What are the causes, symptoms, and management of this condition? Explore the answers to these questions and more in this comprehensive article.</p></blockquote><div id="ez-toc-container" class="ez-toc-v2_0_11 counter-hierarchy counter-decimal ez-toc-grey"><div class="ez-toc-title-container"><p class="ez-toc-title">Содержание</p> <span class="ez-toc-title-toggle"><a class="ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle"><i class="ez-toc-glyphicon ez-toc-icon-toggle"></i></a></span></div><nav><ul class="ez-toc-list ez-toc-list-level-1"><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-1" href="#Understanding_Postpartum_Spontaneous_Vulvar_Hematoma" title="Understanding Postpartum Spontaneous Vulvar Hematoma">Understanding Postpartum Spontaneous Vulvar Hematoma</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-2" href="#Causes_and_Risk_Factors_of_Vulvar_Hematoma" title="Causes and Risk Factors of Vulvar Hematoma">Causes and Risk Factors of Vulvar Hematoma</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-3" href="#Symptoms_and_Diagnosis_of_Vulvar_Hematoma" title="Symptoms and Diagnosis of Vulvar Hematoma">Symptoms and Diagnosis of Vulvar Hematoma</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-4" href="#Maternal_Near_Miss_and_Postpartum_Hemorrhage" title="Maternal Near Miss and Postpartum Hemorrhage">Maternal Near Miss and Postpartum Hemorrhage</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-5" href="#Management_and_Treatment_of_Vulvar_Hematoma" title="Management and Treatment of Vulvar Hematoma">Management and Treatment of Vulvar Hematoma</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-6" href="#Complications_and_Outcomes_of_Vulvar_Hematoma" title="Complications and Outcomes of Vulvar Hematoma">Complications and Outcomes of Vulvar Hematoma</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-7" href="#Importance_of_Timely_Intervention" title="Importance of Timely Intervention">Importance of Timely Intervention</a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-8" href="#Postpartum_spontaneous_vulvar_hematoma_as_a_cause_of_maternal_near_miss_a_case_report_and_review_of_the_literature" title="Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature">Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature</a><ul class="ez-toc-list-level-4"><li class="ez-toc-heading-level-4"><ul class="ez-toc-list-level-4"><li class="ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-9" href="#Background" title="Background">Background</a></li><li class="ez-toc-page-1 ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-10" href="#Case_summary" title="Case summary">Case summary</a></li><li class="ez-toc-page-1 ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-11" href="#Conclusion" title="Conclusion">Conclusion</a></li><li class="ez-toc-page-1 ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-12" href="#Table_1" title="Table 1">Table 1</a></li><li class="ez-toc-page-1 ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-13" href="#Authors%E2%80%99_details" title="Authors’ details">Authors’ details</a></li></ul></li></ul></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-14" href="#Symptoms,_Causes,_Diagnosis,_and_Treatment" title="Symptoms, Causes, Diagnosis, and Treatment">Symptoms, Causes, Diagnosis, and Treatment</a><ul class="ez-toc-list-level-4"><li class="ez-toc-heading-level-4"><ul class="ez-toc-list-level-4"><li class="ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-15" href="#How_we_reviewed_this_article" title="How we reviewed this article:">How we reviewed this article:</a></li><li class="ez-toc-page-1 ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-16" href="#Read_this_next" title="Read this next">Read this next</a></li></ul></li></ul></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-17" href="#Medical_Bulletin_of_the_North_Caucasus_Scientific_and_practical_journal" title=" Medical Bulletin of the North Caucasus :: Scientific and practical journal "> Medical Bulletin of the North Caucasus :: Scientific and practical journal </a></li><li class="ez-toc-page-1 ez-toc-heading-level-2"><a class="ez-toc-link ez-toc-heading-18" href="#Consequences_of_childbirth_cephalohematoma_in_the_future_%E2%80%93_important_information_for_parents_%E2%80%93_Dobrobut_Clinic" title=" Consequences of childbirth cephalohematoma in the future – important information for parents – Dobrobut Clinic "> Consequences of childbirth cephalohematoma in the future – important information for parents – Dobrobut Clinic </a><ul class="ez-toc-list-level-3"><li class="ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-19" href="#Cephalohematoma_in_newborns_on_the_head_%E2%80%93_symptoms,_treatment" title=" Cephalohematoma in newborns on the head – symptoms, treatment "> Cephalohematoma in newborns on the head – symptoms, treatment </a></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-20" href="#Classification_of_cephalohematoma" title=" Classification of cephalohematoma "> Classification of cephalohematoma </a></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-21" href="#Signs_of_ossified_cephalohematoma" title=" Signs of ossified cephalohematoma "> Signs of ossified cephalohematoma </a></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-22" href="#Diagnosis" title=" Diagnosis "> Diagnosis </a></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-23" href="#Treatment_of_cephalohematoma_in_a_child" title=" Treatment of cephalohematoma in a child "> Treatment of cephalohematoma in a child </a></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-24" href="#Consequences_and_prognosis" title=" Consequences and prognosis "> Consequences and prognosis </a><ul class="ez-toc-list-level-4"><li class="ez-toc-heading-level-4"><a class="ez-toc-link ez-toc-heading-25" href="#Do_you_want_to_get_an_online_explanation_from_the_doctor_of_the_Dobrobut_MS" title=" Do you want to get an online explanation from the doctor of the Dobrobut MS? "> Do you want to get an online explanation from the doctor of the Dobrobut MS? </a></li></ul></li><li class="ez-toc-page-1 ez-toc-heading-level-3"><a class="ez-toc-link ez-toc-heading-26" href="#Our_certificates" title=" Our certificates "> Our certificates </a></li></ul></li></ul></nav></div><h2><span class="ez-toc-section" id="Understanding_Postpartum_Spontaneous_Vulvar_Hematoma"></span>Understanding Postpartum Spontaneous Vulvar Hematoma<span class="ez-toc-section-end"></span></h2><p>Postpartum spontaneous vulvar hematoma is a rare but potentially life-threatening complication of childbirth. It occurs when a collection of blood forms in the vulva, the external female genitalia, following the delivery of a baby. This condition can lead to severe maternal morbidity, known as maternal near miss, if not managed properly and in a timely manner.</p><h2><span class="ez-toc-section" id="Causes_and_Risk_Factors_of_Vulvar_Hematoma"></span>Causes and Risk Factors of Vulvar Hematoma<span class="ez-toc-section-end"></span></h2><p>The vulva is composed of soft tissue, including smooth muscle and loose connective tissue, and is supplied by branches of the pudendal artery. During pregnancy, the increasing weight of the uterus can lead to the development of varicosities, or dilated veins, in the vulvar vasculature, especially in parous (having given birth) women. Damage to these labial branches of the internal pudendal artery can initiate the formation of a hematoma.</p><p><img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.seoptimer.com/storage/images/2018/09/5746-meta-description-in-serp.png' /><noscript><img loading='lazy' src='/800/600/https/www.seoptimer.com/storage/images/2018/09/5746-meta-description-in-serp.png' /></noscript></p><p>Other potential risk factors for the development of postpartum vulvar hematoma include difficult or traumatic delivery, episiotomy, and coagulopathy (blood clotting disorders).</p><h2><span class="ez-toc-section" id="Symptoms_and_Diagnosis_of_Vulvar_Hematoma"></span>Symptoms and Diagnosis of Vulvar Hematoma<span class="ez-toc-section-end"></span></h2><p>The primary symptom of postpartum vulvar hematoma is a gradually increasing swelling of the vulva, often accompanied by vulvar pain. In severe cases, the patient may also experience vaginal bleeding, as seen in the case presented. A physical examination can confirm the presence and extent of the hematoma, and imaging studies such as ultrasound or CT scan may be used to further evaluate the extent of the condition.</p><h2><span class="ez-toc-section" id="Maternal_Near_Miss_and_Postpartum_Hemorrhage"></span>Maternal Near Miss and Postpartum Hemorrhage<span class="ez-toc-section-end"></span></h2><p>Maternal near miss, as defined by the World Health Organization, refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Postpartum hemorrhage, or excessive bleeding after childbirth, is one of the leading causes of maternal near miss, and vulvar hematoma is a potential contributor to this condition.</p><p><img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.seoclerk.com/pics/472821-12HsVK1471682348.jpg' /><noscript><img loading='lazy' src='/800/600/https/www.seoclerk.com/pics/472821-12HsVK1471682348.jpg' /></noscript></p><h2><span class="ez-toc-section" id="Management_and_Treatment_of_Vulvar_Hematoma"></span>Management and Treatment of Vulvar Hematoma<span class="ez-toc-section-end"></span></h2><p>The management of postpartum vulvar hematoma typically involves prompt surgical intervention to evacuate the hematoma, ligate any bleeding vessels, and obliterate the dead space to prevent further bleeding and complications. This procedure is often performed under spinal anesthesia to ensure the patient’s comfort and safety. In addition, supportive measures such as blood transfusion may be necessary to address any associated anemia or coagulopathy.</p><h2><span class="ez-toc-section" id="Complications_and_Outcomes_of_Vulvar_Hematoma"></span>Complications and Outcomes of Vulvar Hematoma<span class="ez-toc-section-end"></span></h2><p>Neglected or inappropriately managed postpartum vulvar hematoma can lead to significant maternal morbidities, such as severe anemia, superinfection, necrotizing fasciitis (a severe, life-threatening soft tissue infection), and prolonged hospitalization. In the case presented, the prompt surgical management and referral to a higher-level facility were crucial in preventing severe complications and maternal mortality.</p><h2><span class="ez-toc-section" id="Importance_of_Timely_Intervention"></span>Importance of Timely Intervention<span class="ez-toc-section-end"></span></h2><p>The case report highlights the importance of timely recognition and appropriate management of postpartum vulvar hematoma to prevent severe maternal morbidity and mortality. Vulvar hematoma, if left neglected or improperly managed, can rapidly progress and lead to life-threatening complications, underscoring the need for healthcare providers to be vigilant in identifying and addressing this rare but serious postpartum complication.</p><p><img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/http/i.pinimg.com/736x/4b/e4/74/4be4744de5b13613d1b292db08433796.jpg' /><noscript><img loading='lazy' src='/800/600/http/i.pinimg.com/736x/4b/e4/74/4be4744de5b13613d1b292db08433796.jpg' /></noscript></p><p>In the presented case, the patient’s initial management at the nearby hospital, including the evacuation of the hematoma and referral to a higher-level facility for further care, was crucial in preventing more severe consequences. The case emphasizes the importance of access to quality obstetric care, even in rural settings, to ensure the timely recognition and appropriate management of postpartum complications like vulvar hematoma.</p><p>Overall, this case report serves as a valuable reminder for healthcare providers to be aware of the potential for postpartum vulvar hematoma, its associated risks, and the necessity of prompt surgical intervention to avert severe maternal morbidity and mortality. By enhancing understanding and awareness of this rare but serious complication, healthcare systems can work to improve maternal outcomes and reduce the burden of maternal near miss in regions with limited resources, such as rural Ethiopia.</p><p></p><h2><span class="ez-toc-section" id="Postpartum_spontaneous_vulvar_hematoma_as_a_cause_of_maternal_near_miss_a_case_report_and_review_of_the_literature"></span>Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature<span class="ez-toc-section-end"></span></h2><ul><li> Journal List</li><li> J Med Case Rep</li><li> v.16; 2022</li><li aria-current="page"> PMC8883656</li></ul><p>As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with,<br /> the contents by NLM or the National Institutes of Health.</p><p> Learn more about our disclaimer.</p><p>J Med Case Rep. 2022; 16: 85.</p><p>Published online 2022 Feb 28. doi: 10.1186/s13256-022-03281-2</p><p>,<sup></sup><sup>1</sup>,<sup>1</sup>,<sup>1</sup> and <sup>2</sup></p><p>Author information Article notes Copyright and License information Disclaimer</p><dl data-length="109"><dt>Data Availability Statement</dt></dl><h4><span class="ez-toc-section" id="Background"></span>Background<span class="ez-toc-section-end"></span></h4><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='' /><noscript><img loading='lazy' src='' /></noscript></p><h4><span class="ez-toc-section" id="Case_summary"></span>Case summary<span class="ez-toc-section-end"></span></h4><p>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.</p><h4><span class="ez-toc-section" id="Conclusion"></span>Conclusion<span class="ez-toc-section-end"></span></h4><p>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</p><p><strong>Keywords: </strong>Vulvar hematoma, Postpartum, Severe anemia, Maternal near miss</p><p>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].<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/elispot.biz/800/600/http/slideplayer.gr/slide/15756845/88/images/5/%CE%94%CE%99%CE%91%CE%A4%CE%9F%CE%99%CE%A7%CE%A9%CE%9C%CE%91%CE%A4%CE%99%CE%9A%CE%9F+%CE%91%CE%99%CE%9C%CE%91%CE%A4%CE%A9%CE%9C%CE%91.jpg' /><noscript><img loading='lazy' src='/800/600/https/elispot.biz/800/600/http/slideplayer.gr/slide/15756845/88/images/5/%CE%94%CE%99%CE%91%CE%A4%CE%9F%CE%99%CE%A7%CE%A9%CE%9C%CE%91%CE%A4%CE%99%CE%9A%CE%9F+%CE%91%CE%99%CE%9C%CE%91%CE%A4%CE%A9%CE%9C%CE%91.jpg' /></noscript> 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].</p><p>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].</p><p>Postpartum vulvar hematomas cause maternal morbidities such as anemia, postpartum hemorrhage, superinfection, necrotizing fasciitis, prolonged hospitalization, and need for transfusion [5–7].<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/scontent-hel2-1.cdninstagram.com/v/t51.2885-15/e35/75324987_219836329007500_7397534455459820830_n.jpg?_nc_ht=scontent-hel2-1.cdninstagram.com&_nc_cat=104&_nc_ohc=Va_AvSL9YjUAX8AIIpw&oh=d6e254b1dc50fa699b46a8faa9d0396a&oe=5EB17852' /><noscript><img loading='lazy' src='/800/600/https/scontent-hel2-1.cdninstagram.com/v/t51.2885-15/e35/75324987_219836329007500_7397534455459820830_n.jpg?_nc_ht=scontent-hel2-1.cdninstagram.com&_nc_cat=104&_nc_ohc=Va_AvSL9YjUAX8AIIpw&oh=d6e254b1dc50fa699b46a8faa9d0396a&oe=5EB17852' /></noscript> Here we present, a case of postpartum vulvar hematoma as the cause of MNM.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/africanhealthsciences.org/wp-content/uploads/2017/09/1-3.jpg' /><noscript><img loading='lazy' src='/800/600/https/africanhealthsciences.org/wp-content/uploads/2017/09/1-3.jpg' /></noscript> 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.</p><p>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.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/tacon.ru/wp-content/uploads/7/a/0/7a05f6638d1c87bf402c822bddd6caae.jpeg' /><noscript><img loading='lazy' src='/800/600/https/tacon.ru/wp-content/uploads/7/a/0/7a05f6638d1c87bf402c822bddd6caae.jpeg' /></noscript> 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 .</p><p>Open in a separate window</p><p>Postpartum spontaneous vulvar hematoma managed at Wollega University Referral Hospital, Western Ethiopia, 2021</p><h4><span class="ez-toc-section" id="Table_1"></span>Table 1<span class="ez-toc-section-end"></span></h4><p>Summary of laboratory investigations of the case of postpartum spontaneous vulvar hematoma managed at Wollega University Referral Hospital, Western Ethiopia, 2021</p><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Time of investigations</th><th align="left" rowspan="1" colspan="1">Laboratory tests</th><th align="left" rowspan="1" colspan="1">Results</th></tr></thead><tbody><tr><td align="left" rowspan="7" colspan="1">At admission</td><td align="left" rowspan="1" colspan="1">CBC count</td><td align="left" rowspan="1" colspan="1">WBC count 1760 cells/μl; RBC count 1.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.verywellfamily.com/thmb/2-cuNMlCV1b0WMVqndLXHT1r3x4=/1500x1000/filters:fill(DBCCE8,1)/subchorionic-hematoma-2371262-FINAL-f6087842ac05492db024d87f87700082.png' /><noscript><img loading='lazy' src='/800/600/https/www.verywellfamily.com/thmb/2-cuNMlCV1b0WMVqndLXHT1r3x4=/1500x1000/filters:fill(DBCCE8,1)/subchorionic-hematoma-2371262-FINAL-f6087842ac05492db024d87f87700082.png' /></noscript> 1 million cells/μL; hematocrit 10.3%<sup>a</sup>; platelet count 189,000 cells/μl; MCV 92.2 fL; MCH 30.6 picograms(pg)</td></tr><tr><td align="left" rowspan="1" colspan="1">Urinalysis</td><td align="left" rowspan="1" colspan="1">Nonrevealing</td></tr><tr><td align="left" rowspan="1" colspan="1">RBG</td><td align="left" rowspan="1" colspan="1">145 mg/dl</td></tr><tr><td align="left" rowspan="1" colspan="1">Blood group</td><td align="left" rowspan="1" colspan="1">B+</td></tr><tr><td align="left" rowspan="1" colspan="1">Abdominopelvic ultrasound</td><td align="left" rowspan="1" colspan="1">Empty uterus, no peritoneal collection</td></tr><tr><td align="left" rowspan="1" colspan="1">VDRL</td><td align="left" rowspan="1" colspan="1">Nonreactive</td></tr><tr><td align="left" rowspan="1" colspan="1">HBsAg</td><td align="left" rowspan="1" colspan="1">Nonreactive</td></tr><tr><td align="left" rowspan="3" colspan="1">After procedure</td><td align="left" rowspan="3" colspan="1">CBC count</td><td align="left" rowspan="1" colspan="1">WBC count 1971 cells/μl; RBC count 1.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/myhealthgazette.com/wp-content/uploads/2021/04/pjimage-2021-04-27T172600.524.jpg' /><noscript><img loading='lazy' src='/800/600/https/myhealthgazette.com/wp-content/uploads/2021/04/pjimage-2021-04-27T172600.524.jpg' /></noscript> 4 million cells/μl; platelet count 177,000 cells/μl; MCV 92.1 fL; MCH 30.7 picograms(pg)</td></tr><tr><td align="left" rowspan="1" colspan="1">Hematocrit 12.9%<sup>b</sup></td></tr><tr><td align="left" rowspan="1" colspan="1">Hematocrit 17.2%<sup>c</sup></td></tr></tbody></table><p>Open in a separate window</p><p><em>CBC</em> complete blood count, <em>WBC</em> white blood cell, <em>RBC</em> red blood cell, <em>VDRL</em> Venereal Disease Research Laboratory, <em>HBsAg</em> hepatitis B surface antigen, <em>RBG</em> random blood glucose, <em>MCV</em> mean corpuscular volume, <em>MCH</em> mean corpuscular hemoglobin</p><p><sup>a</sup>At admission</p><p><sup>b</sup>After the first transfusion</p><p><sup>c</sup>After the second transfusion</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/pbs.twimg.com/media/C-ayJAhXkAAg-VP.jpg' /><noscript><img loading='lazy' src='/800/600/https/pbs.twimg.com/media/C-ayJAhXkAAg-VP.jpg' /></noscript> 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.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/i.ytimg.com/vi/CFdJiwu_SkE/maxresdefault.jpg' /><noscript><img loading='lazy' src='/800/600/https/i.ytimg.com/vi/CFdJiwu_SkE/maxresdefault.jpg' /></noscript> 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.</p><p>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].</p><p>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].<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/image.babydestination.com/wp-content/uploads/2017/03/PERIODS-AFTER-DELIVERY-1.jpg' /><noscript><img loading='lazy' src='/800/600/https/image.babydestination.com/wp-content/uploads/2017/03/PERIODS-AFTER-DELIVERY-1.jpg' /></noscript> 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.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/medbur.ru/wp-content/uploads/obvitie-pupoviny-vokrug-shei-ploda.jpg' /><noscript><img loading='lazy' src='/800/600/https/medbur.ru/wp-content/uploads/obvitie-pupoviny-vokrug-shei-ploda.jpg' /></noscript></p><p>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.</p><p>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].<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/healthjade.net/wp-content/uploads/2021/11/Abruptio-placentae.jpg' /><noscript><img loading='lazy' src='/800/600/https/healthjade.net/wp-content/uploads/2021/11/Abruptio-placentae.jpg' /></noscript> 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].<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.millerandzois.com/photos/differences_cephalohematoma_caput_succedaneum_infographic.jpg' /><noscript><img loading='lazy' src='/800/600/https/www.millerandzois.com/photos/differences_cephalohematoma_caput_succedaneum_infographic.jpg' /></noscript></p><p>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 maternal complications</p><p>We thank the patient for allowing the publication of this case report.</p><h4><span class="ez-toc-section" id="Authors%E2%80%99_details"></span>Authors’ details<span class="ez-toc-section-end"></span></h4><p>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.</p><table><tbody><tr><td>ANC</td><td>Antenatal care</td></tr><tr><td>CBC</td><td>Complete blood count</td></tr><tr><td>HBsAg</td><td>Hepatitis B surface antigen</td></tr><tr><td>LNMP</td><td>Last normal menstrual period</td></tr><tr><td>MCH</td><td>Mean corpuscular hemoglobin</td></tr><tr><td>MCV</td><td>Mean corpuscular volume</td></tr><tr><td>MNM</td><td>Maternal near miss</td></tr><tr><td>PPH</td><td>Postpartum hemorrhage</td></tr><tr><td>RBC</td><td>Red blood cell</td></tr><tr><td>RBG</td><td>Random blood glucose</td></tr><tr><td>VDRL</td><td>Venereal Disease Research Laboratory</td></tr><tr><td>WBC</td><td>White blood cell</td></tr><tr><td>WUR</td><td>Wollega University Referral Hospital</td></tr></tbody></table><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/ak.picdn.net/shutterstock/videos/1017520324/thumb/1.jpg' /><noscript><img loading='lazy' src='/800/600/https/ak.picdn.net/shutterstock/videos/1017520324/thumb/1.jpg' /></noscript> All authors read and approved the final manuscript.</p><p>No funding source</p><p>The datasets used during the current study are available from the corresponding author on reasonable request.</p><p>Ethics approval and consent to participate</p><p>Wollega University Referral Hospital has approved the publication of this case. The study protocol is performed per the relevant guidelines.</p><p>Consent for publication</p><p>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.</p><p>Competing interests</p><p>The authors report no competing interests.</p><p><strong>Publisher’s Note</strong></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p>1. World Health Organization. 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[PubMed] [Google Scholar]</p><hr/><p>Articles from Journal of Medical Case Reports are provided here courtesy of <strong>BioMed Central</strong></p><hr/><h2><span class="ez-toc-section" id="Symptoms,_Causes,_Diagnosis,_and_Treatment"></span>Symptoms, Causes, Diagnosis, and Treatment<span class="ez-toc-section-end"></span></h2><p>Vaginal Hematoma: Symptoms, Causes, Diagnosis, and Treatment</p><ul><li>Health Conditions<ul><li>Featured<ul><li>Breast Cancer</li><li>IBD</li><li>Migraine</li><li>Multiple Sclerosis (MS)</li><li>Rheumatoid Arthritis</li><li>Type 2 Diabetes</li><li/></ul></li><li>Articles<ul><li>Acid Reflux</li><li>ADHD</li><li>Allergies</li><li>Alzheimer’s & Dementia</li><li>Bipolar Disorder</li><li>Cancer</li><li>Crohn’s Disease</li><li>Chronic Pain</li><li>Cold & Flu</li><li>COPD</li><li>Depression</li><li>Fibromyalgia</li><li>Heart Disease</li><li>High Cholesterol</li><li>HIV</li><li>Hypertension</li><li>IPF</li><li>Osteoarthritis</li><li>Psoriasis</li><li>Skin Disorders and Care</li><li>STDs</li></ul></li></ul></li><li>Discover<ul><li>Wellness Topics<ul><li>Nutrition</li><li>Fitness</li><li>Skin Care</li><li>Sexual Health</li><li>Women’s Health</li><li>Mental Well-Being</li><li>Sleep</li></ul></li><li>Product Reviews<ul><li>Vitamins & Supplements</li><li>Sleep</li><li>Mental Health</li><li>Nutrition</li><li>At-Home Testing</li><li>CBD</li><li>Men’s Health</li></ul></li><li>Original Series<ul><li>Fresh Food Fast</li><li>Diagnosis Diaries</li><li>You’re Not Alone</li><li>Present Tense</li></ul></li><li>Video Series<ul><li>Youth in Focus</li><li>Healthy Harvest</li><li>No More Silence</li><li>Future of Health</li></ul></li></ul></li><li>Plan<ul><li>Health Challenges<ul><li>Mindful Eating</li><li>Sugar Savvy</li><li>Move Your Body</li><li>Gut Health</li><li>Mood Foods</li><li>Align Your Spine</li></ul></li><li>Find Care<ul><li>Primary Care</li><li>Mental Health</li><li>OB-GYN</li><li>Dermatologists</li><li>Neurologists</li><li>Cardiologists</li><li>Orthopedists</li></ul></li><li>Lifestyle Quizzes<ul><li>Weight Management</li><li>Am I Depressed? A Quiz for Teens</li><li>Are You a Workaholic?</li><li>How Well Do You Sleep?</li></ul></li><li>Tools & Resources<ul><li>Health News</li><li>Find a Diet</li><li>Find Healthy Snacks</li><li>Drugs A-Z</li><li>Health A-Z</li></ul></li></ul></li><li>Connect<ul><li><ul><li>Breast Cancer</li><li>Inflammatory Bowel Disease</li><li>Psoriatic Arthritis</li><li>Migraine</li><li>Multiple Sclerosis</li><li>Psoriasis</li></ul></li><li/></ul></li></ul><p>Medically reviewed by Cynthia Cobb, DNP, APRN, WHNP-BC, FAANP — By Donna Christiano — Updated on April 24, 2018</p><h3></h3><p> What is a vaginal hematoma?</p></h3><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/images.slideplayer.com/32/10033384/slides/slide_15.jpg' /><noscript><img loading='lazy' src='/800/600/https/images.slideplayer.com/32/10033384/slides/slide_15.jpg' /></noscript> 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.</p><p>Keep reading to learn more about the symptoms of a vaginal hematoma and what kind of treatments are available.</p><p>In many cases, a small vaginal hematoma won’t cause any symptoms. Larger hematomas may cause:</p><ul><li><strong>Pain and swelling.</strong> You may be able to feel or see a mass covered by purple- or blue-colored skin, similar to a bruise.</li><li><strong>Painful or difficult urination.</strong> 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.</li><li><strong>Bulging tissue.</strong> Very large hematomas sometimes extend outside of the vagina.</li></ul><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/elispot.biz/800/600/http/images.slideplayer.com/19/5849709/slides/slide_5.jpg' /><noscript><img loading='lazy' src='/800/600/https/elispot.biz/800/600/http/images.slideplayer.com/19/5849709/slides/slide_5.jpg' /></noscript></p><p>Several things can injure the vagina, including:</p><ul><li>falling</li><li>vigorous sexual intercourse</li><li>high-impact sports</li></ul><p>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.</p><p>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.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.babyledweaningideas.com/wp-content/uploads/2018/03/birth-lewis.jpg' /><noscript><img loading='lazy' src='/800/600/https/www.babyledweaningideas.com/wp-content/uploads/2018/03/birth-lewis.jpg' /></noscript></p><p>There are several treatment options for vaginal hematomas, depending on how large they are and whether they’re causing symptoms.</p><p>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.</p><p>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.</p><p>Very large hematomas, or hematomas located deep in the vagina, may require heavier sedation and more extensive surgery.</p><p>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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/i.ytimg.com/vi/cvGfWbAvNBY/maxresdefault.jpg' /><noscript><img loading='lazy' src='/800/600/https/i.ytimg.com/vi/cvGfWbAvNBY/maxresdefault.jpg' /></noscript> 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.</p><p> Last medically reviewed on April 24, 2018</p><h4><span class="ez-toc-section" id="How_we_reviewed_this_article"></span>How we reviewed this article:<span class="ez-toc-section-end"></span></h4><p>Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.</p><ul><li><cite>Awoleke JO. (2017). Vulvovaginal infralevator haematoma mimicking the second stage of labour [Abstract]. DOI:<br />10.1155/2017/8062793</cite></li><li><cite>Mayo Clinic. (2017). Shock: First aid.<br />mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620</cite></li><li><cite>Postpartum hemorrhage. (2017).<br />clinicalinnovations.com/wp-content/uploads/2017/10/ACOG_Practice_Bulletin_No_183_Postpartum-Hemorrhage-2017.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/cdn.hellosehat.com/wp-content/uploads/2019/08/melahirkan-dengan-forceps-forsep.jpg' /><noscript><img loading='lazy' src='/800/600/https/cdn.hellosehat.com/wp-content/uploads/2019/08/melahirkan-dengan-forceps-forsep.jpg' /></noscript> pdf</cite></li><li><cite>Puerperal genital haematomas. (n.d.).<br />sahealth.sa.gov.au/wps/wcm/connect/149020804eedac35b186b36a7ac0d6e4/Puerperal-genital-haematomas-WCHN-PPG-22052013.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-149020804eedac35b186b36a7ac0d6e4-lNuWuA-</cite></li><li><cite>Roman AS, et al. (2017). Management of hematomas incurred as a result of obstetrical delivery.<br />uptodate.com/contents/management-of-hematomas-incurred-as-a-result-of-obstetrical-delivery</cite></li></ul><p>Share this article</p><p>Medically reviewed by Cynthia Cobb, DNP, APRN, WHNP-BC, FAANP — By Donna Christiano — Updated on April 24, 2018</p><p><h4><span class="ez-toc-section" id="Read_this_next"></span>Read this next<span class="ez-toc-section-end"></span></h4></p><ul><li>What Causes Vaginal Burning, and How Is It Treated?</p><p>Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT</p><p>Vaginal itching and irritation usually aren’t cause for concern, but burning may be a sign of an underlying condition. 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What causes them and are they dangerous?</p><p>READ MORE</p></li></ul><h2><span class="ez-toc-section" id="Medical_Bulletin_of_the_North_Caucasus_Scientific_and_practical_journal"></span> Medical Bulletin of the North Caucasus :: Scientific and practical journal <span class="ez-toc-section-end"></span></h2><p>Medical Bulletin <br /> of the North Caucasus</p><p> Scientific and practical journal</p><p> Registered with the Federal Service<br /> <br /> Compliance<br /> <br /> in mass communications<br /> <br /> and protection of cultural heritage<br /> <br /> PI No. ФС77-26521 dated December 7, 2006<br /> ISSN <br /> 2073-8137</p><p>Russian</p><p>english</p><ul></ul><p> Site search</p><p></p><hr size="1" /><p> <b> Editorial address </b> <br /> 355017, Stavropol, Mira street, 310.</p><p> <b> E-mail </b> <br /> medvestnik@stgmu.ru</p><p> 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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/s3.amazonaws.com/arc-wordpress-client-uploads/infobae-wp/wp-content/uploads/2018/02/08125146/nacimiento_pasillo_hospital_3.jpg' /><noscript><img loading='lazy' src='/800/600/https/s3.amazonaws.com/arc-wordpress-client-uploads/infobae-wp/wp-content/uploads/2018/02/08125146/nacimiento_pasillo_hospital_3.jpg' /></noscript> 6/6, February 2010).</p><p> 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.</p><p> The journal is indexed by: SCOPUS database, Ulrich’s International Periodicals Directory.</p><p> EBSCO</p><p> https://doi.org/10.14300/mnnc.2014.09040</p><p> [Original research] [OB/GYN] <br /> <em> Novikova Vladislava Alexandrovna; Aseeva Evgenia; Corner Natalia; Khorolsky Vadim Alexandrovich; Filina Karina; Kazibekova F ; </em></p><p> 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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/skajite-a.ru/800/600/https/c8.alamy.com/comp/APCJ8H/midwife-delivering-baby-APCJ8H.jpg' /><noscript><img loading='lazy' src='/800/600/https/skajite-a.ru/800/600/https/c8.alamy.com/comp/APCJ8H/midwife-delivering-baby-APCJ8H.jpg' /></noscript> 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.</p><p> Download</p><p> References: <br /> 1. Aylamazyan E. K., Kulakov V. I., Radzinskiy V. E., Savelyeva G. M. Obstetrics: National Guide. M.: “GEOTAR-Media”; 2007. 1200 p. <br /> 2. Obstetrics and gynecology.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/cs9.pikabu.ru/post_img/2017/06/22/7/og_og_1498127678224725427.jpg' /><noscript><img loading='lazy' src='/800/600/https/cs9.pikabu.ru/post_img/2017/06/22/7/og_og_1498127678224725427.jpg' /></noscript> Differential diagnostics from A to Z / Ed. Tony Hollingworth. M.: “GEOTAR-Media”; 2010. 400 p. <br /> 3. Artyimuk N. V. Varicose veins of the small pelvis in women. Russian journal of obstetrician-gynecologist. 2007;6:74-77. <br /> 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. <br /> 5. Bogachev V. Yu. Small pelvis vein disease. Consilium medicum. 2006;1(1):20-23. <br /> 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. <br /> 7. Clinical recommendations. Obstetrics and Gynecology. – 4th edition, revised / Ed. V.N. Serov, G.T. Sukhikh. M.: “GEOTAR-Media”; 2014. P. 499-514. <br /> 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. <br /> 9. Sukhikh G. T., Serov V. N., Savelieva G.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/i.ytimg.com/vi/Vn14vQAIkKk/maxresdefault.jpg' /><noscript><img loading='lazy' src='/800/600/https/i.ytimg.com/vi/Vn14vQAIkKk/maxresdefault.jpg' /></noscript> M. et al. Prevention and therapy of massive blood loss in obstetrics. Medical technology FS No. 2010/141, of 29/04/2010. <br /> 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. <br /> 11. WHO recommendations for prevention and treatment of postpartum hemorrage, 2012.</p><p> Key words: postpartum hemorrhage, massive blood loss, vaginal hematomas</p><p> Founders: <br /> Stavropol State Medical Academy <br /> State Research Institute of Balneology <br /> Pyatigorsk State Pharmaceutical Academy</p><h2><span class="ez-toc-section" id="Consequences_of_childbirth_cephalohematoma_in_the_future_%E2%80%93_important_information_for_parents_%E2%80%93_Dobrobut_Clinic"></span> Consequences of childbirth cephalohematoma in the future – important information for parents – Dobrobut Clinic <span class="ez-toc-section-end"></span></h2><p> Home</p><p> Medical Library Dobrobut</p><p> Publication date: 2020-01-22</p><h3><span class="ez-toc-section" id="Cephalohematoma_in_newborns_on_the_head_%E2%80%93_symptoms,_treatment"></span> Cephalohematoma in newborns on the head – symptoms, treatment <span class="ez-toc-section-end"></span></h3><p> A cephalohematoma is a birth injury characterized by the formation of a hematoma.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/i.ytimg.com/vi/Tb_-SZ4lc68/maxresdefault.jpg?sqp=-oaymwEmCIAKENAF8quKqQMa8AEB-AH-CYAC0AWKAgwIABABGGUgWihVMA8=&rs=AOn4CLAKu7sffsRPx7EVSz7aYDpLm0dhZg' /><noscript><img loading='lazy' src='/800/600/https/i.ytimg.com/vi/Tb_-SZ4lc68/maxresdefault.jpg?sqp=-oaymwEmCIAKENAF8quKqQMa8AEB-AH-CYAC0AWKAgwIABABGGUgWihVMA8=&rs=AOn4CLAKu7sffsRPx7EVSz7aYDpLm0dhZg' /></noscript> 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.</p><p> Causes of cephalohematoma during childbirth:</p><ul><li> large fruit;</li><li> rapid delivery;</li><li> abnormal position of the fetus;</li><li> premature or prolonged labor;</li><li> cord entanglement;</li><li> discrepancy between the size of the pelvis of the mother and the head of the fetus;</li><li> pathology of intrauterine development;</li><li> use during childbirth forceps.</li></ul><h3><span class="ez-toc-section" id="Classification_of_cephalohematoma"></span> Classification of cephalohematoma <span class="ez-toc-section-end"></span></h3><p> 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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/c8.alamy.com/compfr/2begbwp/schema-d-une-section-cesarienne-2begbwp.jpg' /><noscript><img loading='lazy' src='/800/600/https/c8.alamy.com/compfr/2begbwp/schema-d-une-section-cesarienne-2begbwp.jpg' /></noscript></p><p> 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.</p><h3><span class="ez-toc-section" id="Signs_of_ossified_cephalohematoma"></span> Signs of ossified cephalohematoma <span class="ez-toc-section-end"></span></h3><p> 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.</p><p> Main symptoms:</p><ul><li> education has clear boundaries;</li><li> on day 2-3, the growth of the hematoma stops;</li><li> the color of the skin in the area of cephalohematoma is unchanged;</li><li> hematoma soft to the touch;</li><li> the general condition of the baby is unchanged.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/slideplayer.info/12722027/76/images/slide_53.jpg' /><noscript><img loading='lazy' src='/800/600/https/slideplayer.info/12722027/76/images/slide_53.jpg' /></noscript></li></ul><p> 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.</p><h3><span class="ez-toc-section" id="Diagnosis"></span> Diagnosis <span class="ez-toc-section-end"></span></h3><p> 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.</p><h3><span class="ez-toc-section" id="Treatment_of_cephalohematoma_in_a_child"></span> Treatment of cephalohematoma in a child <span class="ez-toc-section-end"></span></h3><p> 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.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/1.bp.blogspot.com/-yW3tNCbPqFA/WfFh-KvXHiI/AAAAAAAACV0/-IDOPwngWa806vADIw3gbBXsb7Az8-K6ACLcBGAs/s1600/Apa%2BBerlaku%2BPda%2BBadan%2BLepas%2BBersalin.jpg' /><noscript><img loading='lazy' src='/800/600/https/1.bp.blogspot.com/-yW3tNCbPqFA/WfFh-KvXHiI/AAAAAAAACV0/-IDOPwngWa806vADIw3gbBXsb7Az8-K6ACLcBGAs/s1600/Apa%2BBerlaku%2BPda%2BBadan%2BLepas%2BBersalin.jpg' /></noscript></p><p> 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.</p><p> 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.</p><p> Doctor’s recommendations after the puncture:</p><ul><li> parents must strictly follow the specialist’s instructions;</li><li> in no case should you self-medicate;</li><li> protect the newborn’s head from injury;</li><li> use a cap one size larger;</li><li> closely monitor the general condition of the baby.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/a57.foxnews.com/static.foxnews.com/foxnews.com/content/uploads/2018/09/1024/512/Erica-Morales-Death.jpg?ve=1&tl=1' /><noscript><img loading='lazy' src='/800/600/https/a57.foxnews.com/static.foxnews.com/foxnews.com/content/uploads/2018/09/1024/512/Erica-Morales-Death.jpg?ve=1&tl=1' /></noscript></li></ul><h3><span class="ez-toc-section" id="Consequences_and_prognosis"></span> Consequences and prognosis <span class="ez-toc-section-end"></span></h3><p> 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.</p><p> Most severe consequences:</p><ul><li> infection of the meninges;</li><li> anemia;</li><li> compression of the optic (auditory) nerves;</li><li> suppuration;</li><li> ossification of cephalohematoma with irreversible deformation of the skull bones.</li></ul><p> If you have any questions, sign up for a consultation by phone or fill out the form on the website.</p><p> <strong> Related services:<br /> <br /> Pediatric consultation <br /> Breastfeeding, its role in a child’s life </strong></p><h4><span class="ez-toc-section" id="Do_you_want_to_get_an_online_explanation_from_the_doctor_of_the_Dobrobut_MS"></span> Do you want to get an online explanation from the doctor of the Dobrobut MS? <span class="ez-toc-section-end"></span></h4><p> Download our Google Play App and App Store</p><p> Our Doctors</p><p> See all doctors 782</p><h3><span class="ez-toc-section" id="Our_certificates"></span> Our certificates <span class="ez-toc-section-end"></span></h3><p> Certificate No.<img class="lazy lazy-hidden" loading='lazy' src="//elispot.biz/wp-content/plugins/a3-lazy-load/assets/images/lazy_placeholder.gif" data-lazy-type="image" data-src='/800/600/https/www.babycenter.com/ims/2019/09/bc-subchorionic-hematoma-color-logo_square.jpg' /><noscript><img loading='lazy' src='/800/600/https/www.babycenter.com/ims/2019/09/bc-subchorionic-hematoma-color-logo_square.jpg' /></noscript> QIZ 804 468 C1</p><p> Certificate no. 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