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

11.08.202306.07.2023 by alexxlab

What are the causes and risk factors for postpartum vulvar hematoma. How is postpartum vulvar hematoma diagnosed and treated. What are the potential complications of untreated postpartum vulvar hematoma. How can postpartum vulvar hematoma be prevented.

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Understanding Postpartum Vulvar Hematoma

Postpartum vulvar hematoma is a rare but potentially dangerous complication that can occur after childbirth. It involves the collection of blood in the soft tissues of the vulva, which can lead to significant pain, swelling, and in severe cases, life-threatening blood loss. While uncommon, understanding this condition is crucial for healthcare providers and expectant mothers alike.

What is a vulvar hematoma?

A vulvar hematoma is a localized collection of blood within the soft tissues of the vulva. The vulva, predominantly composed of smooth muscle and loose connective tissue, is richly supplied by branches of the pudendal artery. During pregnancy, the vulvar vasculature often develops varicosities, especially in women who have had previous pregnancies. This is due to increased venous pressure caused by the growing weight of the uterus.

How does a postpartum vulvar hematoma form?

Postpartum vulvar hematomas typically form when there is damage to the labial branches of the internal pudendal artery. This injury can occur during childbirth, particularly in cases of difficult or instrumental deliveries. The damaged blood vessels bleed into the surrounding tissues, forming a hematoma that can rapidly expand due to the loose nature of the vulvar tissue.

Causes and Risk Factors for Postpartum Vulvar Hematoma

Several factors can increase the risk of developing a postpartum vulvar hematoma:

Instrumental deliveries (forceps or vacuum-assisted)
Prolonged second stage of labor
Primiparity (first-time mothers)
Varicose veins in the vulvar area
Coagulation disorders
Precipitous labor
Large fetal size

It’s important to note that while these factors increase the risk, vulvar hematomas can also occur spontaneously, even in seemingly uncomplicated deliveries.

Recognizing the Signs and Symptoms

Early recognition of a postpartum vulvar hematoma is crucial for prompt treatment and prevention of complications. The signs and symptoms typically include:

Severe pain in the vulvar area
Rapid swelling of the vulva, often unilateral
Discoloration of the vulvar skin (purplish or bluish)
Difficulty urinating
Perineal pressure or fullness
Signs of hypovolemia in severe cases (tachycardia, hypotension, pallor)

Healthcare providers should be vigilant for these symptoms, especially in the immediate postpartum period.

Diagnosis and Assessment of Vulvar Hematomas

Diagnosing a postpartum vulvar hematoma typically involves a combination of clinical examination and, in some cases, imaging studies.

Clinical Examination

A thorough physical examination is the primary method of diagnosis. The healthcare provider will inspect the vulva for swelling, discoloration, and tenderness. They may also perform a vaginal examination to assess the extent of the hematoma and rule out other sources of bleeding.

Imaging Studies

In some cases, imaging studies may be necessary to determine the full extent of the hematoma or to rule out other complications. These may include:

Ultrasound: This non-invasive technique can help visualize the size and location of the hematoma.
CT scan: In rare cases, a CT scan may be used to assess deeper tissue involvement or to plan surgical intervention.

Laboratory Tests

Blood tests are often performed to assess the patient’s hemoglobin levels and coagulation status. These tests can help guide treatment decisions, especially regarding the need for blood transfusions.

Treatment Approaches for Postpartum Vulvar Hematoma

The management of postpartum vulvar hematomas depends on the size of the hematoma, the patient’s hemodynamic status, and the presence of ongoing bleeding. Treatment options range from conservative management to surgical intervention.

Conservative Management

For small hematomas (less than 5 cm) and in hemodynamically stable patients, conservative management may be appropriate. This typically involves:

Ice packs to reduce swelling and pain
Analgesics for pain relief
Close monitoring for signs of expansion or infection
Pelvic rest

Surgical Intervention

Larger hematomas or those causing significant symptoms often require surgical management. The surgical approach may include:

Incision and drainage of the hematoma
Identification and ligation of bleeding vessels
Placement of drainage tubes
Layered closure of the wound

In some cases, arterial embolization may be considered as an alternative to open surgery, especially in cases of ongoing bleeding.

Supportive Care

Regardless of the primary treatment approach, supportive care is crucial. This may include:

Blood transfusions in cases of significant blood loss
Antibiotics to prevent or treat infection
Thromboprophylaxis to prevent deep vein thrombosis
Psychological support for the mother

Potential Complications of Untreated Vulvar Hematomas

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

Severe anemia due to ongoing blood loss
Infection and abscess formation
Necrotizing fasciitis in severe cases
Prolonged hospital stay and increased healthcare costs
Psychological distress and impact on mother-infant bonding
Maternal near miss or even maternal death in extreme cases

These potential complications underscore the importance of prompt recognition and appropriate management of vulvar hematomas.

Prevention Strategies for Postpartum Vulvar Hematoma

While not all cases of postpartum vulvar hematoma can be prevented, certain strategies may help reduce the risk:

Careful management of the second stage of labor to avoid prolonged pushing
Judicious use of instrumental delivery techniques
Proper perineal support during delivery
Early recognition and management of vulvar varicosities during pregnancy
Prompt treatment of coagulation disorders
Careful postpartum monitoring, especially in high-risk cases

Healthcare providers should be aware of these preventive measures and implement them as appropriate in their practice.

The Role of Maternal Near Miss in Improving Obstetric Care

The concept of maternal near miss (MNM) is increasingly recognized as an important tool for improving maternal healthcare. As defined by the World Health Organization, MNM refers to “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.”

Why is the concept of maternal near miss important?

Maternal near miss cases provide valuable insights into the quality of obstetric care. By studying these cases, healthcare systems can:

Identify gaps in care provision
Develop targeted interventions to improve maternal outcomes
Allocate resources more effectively
Train healthcare providers in managing severe obstetric complications

In the context of postpartum vulvar hematomas, recognizing these cases as potential MNM events can lead to improved management protocols and better outcomes for affected women.

Case Study: A Real-World Example of Postpartum Vulvar Hematoma

To illustrate the clinical presentation and management of postpartum vulvar hematoma, let’s consider the case of a 28-year-old woman from rural Ethiopia:

Patient History

The patient, a para IV mother, gave birth to a 3000 g female neonate at home with the assistance of traditional birth attendants. She had received antenatal care at a local health center but went into labor rapidly, leading to an unplanned home delivery.

Presentation and Initial Management

Approximately 24 hours after delivery, the patient noticed gradual swelling of her right vulva accompanied by pain. As her symptoms worsened, she was taken to a nearby hospital where a 6 cm Ã— 8 cm vulvar hematoma was diagnosed and evacuated. Due to significant blood loss, she was referred to a larger hospital for blood transfusion.

Complications and Further Management

Upon arrival at the referral hospital, the patient reported ongoing vaginal bleeding and significant vulvar swelling. Clinical examination revealed severe pallor, tachycardia, and hypotension, indicating hypovolemic shock. A large vulvar hematoma was observed, extending to the right labia majora.

The patient was resuscitated with intravenous fluids and blood transfusions. Surgical exploration under spinal anesthesia was performed, revealing active bleeding from branches of the internal pudendal artery. The bleeding vessels were ligated, and the hematoma cavity was obliterated.

Outcome

Following surgical management and supportive care, the patient’s condition stabilized. She and her newborn were discharged on the fourth post-procedure day, with follow-up arrangements in place.

Lessons from the Case Study

This case highlights several important points:

The potential for severe complications even in seemingly uncomplicated deliveries
The importance of prompt recognition and referral in rural settings
The critical role of surgical management in large or expanding hematomas
The need for comprehensive care, including blood transfusion and postoperative monitoring

By studying such cases, healthcare providers can improve their ability to manage similar situations effectively.

Future Directions in Research and Management

While our understanding of postpartum vulvar hematomas has improved, there is still much to learn about this condition. Future research directions may include:

Developing better risk assessment tools to identify women at higher risk of vulvar hematomas
Investigating novel minimally invasive techniques for hematoma management
Studying the long-term outcomes of women who have experienced postpartum vulvar hematomas
Exploring the psychological impact of this complication on affected women and their families
Evaluating the effectiveness of different preventive strategies

As research progresses, we can expect to see improvements in both the prevention and management of this challenging obstetric complication.

The Importance of Education and Awareness

Raising awareness about postpartum vulvar hematomas among healthcare providers, expectant mothers, and the general public is crucial for improving outcomes. This can be achieved through various means:

For Healthcare Providers

Incorporating comprehensive training on vulvar hematomas in obstetric education programs
Conducting regular workshops and simulations to improve diagnostic and management skills
Developing and disseminating clear clinical guidelines for the management of vulvar hematomas

For Expectant Mothers

Including information about potential postpartum complications, including vulvar hematomas, in antenatal education classes
Providing clear guidance on when to seek medical attention for postpartum symptoms
Encouraging open communication between patients and healthcare providers about postpartum concerns

For the General Public

Conducting public health campaigns to raise awareness about maternal health issues
Addressing stigma and misconceptions surrounding postpartum complications
Promoting supportive community attitudes towards maternal health and well-being

By improving education and awareness at all levels, we can hope to reduce the incidence of severe complications from postpartum vulvar hematomas and improve overall maternal health outcomes.

Integrating Postpartum Vulvar Hematoma Management into Healthcare Systems

Effectively managing postpartum vulvar hematomas requires a systems-based approach that integrates prevention, early detection, and prompt treatment. Here are some strategies for improving the management of this condition within healthcare systems:

Standardized Protocols

Developing and implementing standardized protocols for the assessment and management of postpartum vulvar hematomas can help ensure consistent, high-quality care. These protocols should include:

Clear criteria for diagnosing vulvar hematomas
Guidelines for determining the need for conservative versus surgical management
Step-by-step procedures for surgical intervention
Protocols for postoperative care and follow-up

Multidisciplinary Approach

Managing postpartum vulvar hematomas often requires collaboration between various healthcare professionals. A multidisciplinary team approach may include:

Obstetricians and gynecologists
Midwives and obstetric nurses
Anesthesiologists
Interventional radiologists (for cases requiring embolization)
Hematologists (for patients with coagulation disorders)
Mental health professionals (to address psychological impacts)

Resource Allocation

Ensuring that healthcare facilities are adequately equipped to manage vulvar hematomas is crucial. This may involve:

Providing appropriate surgical equipment and supplies
Ensuring availability of blood products for transfusion
Investing in imaging technology for accurate diagnosis and monitoring
Allocating resources for staff training and education

Quality Improvement Initiatives

Implementing ongoing quality improvement processes can help healthcare systems continually enhance their management of postpartum vulvar hematomas. This may include:

Regular audits of vulvar hematoma cases
Analysis of outcomes and complications
Feedback mechanisms for healthcare providers
Continuous updating of protocols based on new evidence and best practices

By integrating these strategies into healthcare systems, we can work towards reducing the morbidity associated with postpartum vulvar hematomas and improving overall 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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Vaginal Hematoma: Symptoms, Causes, Diagnosis, and Treatment

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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

Compliance

in mass communications

and protection of cultural heritage

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

Russian

english

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Editorial address
355017, Stavropol, Mira street, 310.

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[email protected]

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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