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

29.01.202125.07.2023 by alexxlab

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

Journal List
J Med Case Rep
v.16; 2022
PMC8883656

As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with,
the contents by NLM or the National Institutes of Health.

Learn more about our disclaimer.

J Med Case Rep. 2022; 16: 85.

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

,¹,¹,¹ and ²

Author information Article notes Copyright and License information Disclaimer

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 .

Open in a separate window

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.

1. World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. 2011.

2. Gebrehiwot Y, Tewolde BT. Improving maternity care in Ethiopia through facility-based review of maternal deaths and near misses. Int J Gynecol Obstet. 2014;127:S29–34. doi: 10.1016/j.ijgo.2014.08.003. [PubMed] [CrossRef] [Google Scholar]

3. Tura AK, Zwart J, van Roosmalen J, Stekelenburg J, van den Akker T, Scherjon S. Severe maternal outcomes in eastern Ethiopia: application of the adapted maternal near miss tool. PLoS ONE. 2018;13(11):e0207350. doi: 10.1371/journal.pone.0207350. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

4. Wormer KC, Jamil RT, Bryant SB. Acute Postpartum Hemorrhage. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499988/.

5. Anass E et al. Post-partum hemorrhagic shock following puerperal hematoma. PAMJ Clin Med. 2020;3(43). 10.11604/pamj-cm.2020.3.43.2310.

6. Oong GC, Eruo FU. Vulvar Hematoma. [Updated 2021 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560753/.

7. Mangwi AA, Ebasone PV, Aroke D, Ngek LT, Nji AS. Non-obstetric vulva hematomas in a low resource setting: two case reports. Pan Afr Med J. 2019;33:314. doi: 10.11604/pamj.2019.33.314.19488. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Hong HR, Hwang KR, Kim SA, et al. A case of vulvar hematoma with rupture of pseudoaneurysm of a pudendal artery. Obstet Gynecol Sci. 2014;57(2):168–171. doi: 10.5468/ogs.2014.57.2.168. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

9. Gulbasi C, et al. Surgical management and clinical follow-up of post-coital severe vulvar hematoma in a 14-year-old adolescent girl: a case presentation. Acta Biomed. 2021;92(Supplement 1):e2021041. [PMC free article] [PubMed] [Google Scholar]

10. Shivhare S, et al. Endovascular management of episiotomy site hematoma. Turk J Obstet Gynecol. 2021;18:163–166. doi: 10.4274/tjod.galenos.2021.43958. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

11. Gurtovaya Y, Hanna H, Wagley A. Spontaneous intrapartum vulvar hematoma. Midwives. 2013;16(5):48–49. [PubMed] [Google Scholar]

12. Orugbom Ndu-Akinla C, Paul Dienye N, Owajionyi Dienye P. Vulvovaginal haematoma presenting in the puerperium: a case report. GSC Adv Res Rev. 2021;06(03):083–086. doi: 10.30574/gscarr.2021.6.3.0036. [CrossRef] [Google Scholar]

13. Nagayama C, Gibo M, Nitta H, Uezato T, Hirakawa M, Masamoto H, et al. Rupture of pseudoaneurysm after vaginal delivery successfully treated by selective arterial embolization. Arch Gynecol Obstet. 2011;283:37–40. doi: 10.1007/s00404-009-1271-1. [PubMed] [CrossRef] [Google Scholar]

14. Tseng JY, Lin IC, Lin JH, Chang CM, Chao WT, Wang PH. The optimal approach for management of postpartum vulva hematoma: report of three cases. Taiwan J Obstet Gynecol. 2020;59(5):780–783. doi: 10.1016/j.tjog.2020. 07.030. [PubMed] [CrossRef] [Google Scholar]

15. Egan E, Dundee P, Lawrentschuk N. Vulvar hematoma secondary to spontaneous rupture of the internal iliac artery: a clinical review. Am J Obstet Gynecol. 2009;200(1):e17–e18. doi: 10.1016/j.ajog.2008.09.024. [PubMed] [CrossRef] [Google Scholar]

16. Benrubi G, Neuman C, Nuss RC, Thompson RJ. Vulvar and vaginal hematomas: a retrospective study of conservative versus operative management. South Med J. 1987;80(8):991–994. doi: 10.1097/00007611-198708000-00014. [PubMed] [CrossRef] [Google Scholar]

17. Villella J, Garry D, Levine G, Glanz S, Figueroa R, Maulik D. Postpartum angiographic embolization for vulvovaginal hematoma. A report of two cases. J Reprod Med. 2001;46(1):65–67. [PubMed] [Google Scholar]

Articles from Journal of Medical Case Reports are provided here courtesy of BioMed Central

Symptoms, Causes, Diagnosis, and Treatment

Vaginal Hematoma: Symptoms, Causes, Diagnosis, and Treatment

Health Conditions
- Featured
  - Breast Cancer
  - IBD
  - Migraine
  - Multiple Sclerosis (MS)
  - Rheumatoid Arthritis
  - Type 2 Diabetes
- Articles
  - Acid Reflux
  - ADHD
  - Allergies
  - Alzheimer’s & Dementia
  - Bipolar Disorder
  - Cancer
  - Crohn’s Disease
  - Chronic Pain
  - Cold & Flu
  - COPD
  - Depression
  - Fibromyalgia
  - Heart Disease
  - High Cholesterol
  - HIV
  - Hypertension
  - IPF
  - Osteoarthritis
  - Psoriasis
  - Skin Disorders and Care
  - STDs
Discover
- Wellness Topics
  - Nutrition
  - Fitness
  - Skin Care
  - Sexual Health
  - Women’s Health
  - Mental Well-Being
  - Sleep
- Product Reviews
  - Vitamins & Supplements
  - Sleep
  - Mental Health
  - Nutrition
  - At-Home Testing
  - CBD
  - Men’s Health
- Original Series
  - Fresh Food Fast
  - Diagnosis Diaries
  - You’re Not Alone
  - Present Tense
- Video Series
  - Youth in Focus
  - Healthy Harvest
  - No More Silence
  - Future of Health
Plan
- Health Challenges
  - Mindful Eating
  - Sugar Savvy
  - Move Your Body
  - Gut Health
  - Mood Foods
  - Align Your Spine
- Find Care
  - Primary Care
  - Mental Health
  - OB-GYN
  - Dermatologists
  - Neurologists
  - Cardiologists
  - Orthopedists
- Lifestyle Quizzes
  - Weight Management
  - Am I Depressed? A Quiz for Teens
  - Are You a Workaholic?
  - How Well Do You Sleep?
- Tools & Resources
  - Health News
  - Find a Diet
  - Find Healthy Snacks
  - Drugs A-Z
  - Health A-Z
Connect
- - Breast Cancer
  - Inflammatory Bowel Disease
  - Psoriatic Arthritis
  - Migraine
  - Multiple Sclerosis
  - Psoriasis

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

How we reviewed this article:

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.

Awoleke JO. (2017). Vulvovaginal infralevator haematoma mimicking the second stage of labour [Abstract]. DOI:
10.1155/2017/8062793
Mayo Clinic. (2017). Shock: First aid.
mayoclinic.org/first-aid/first-aid-shock/basics/art-20056620
Postpartum hemorrhage. (2017).
clinicalinnovations.com/wp-content/uploads/2017/10/ACOG_Practice_Bulletin_No_183_Postpartum-Hemorrhage-2017. pdf
Puerperal genital haematomas. (n.d.).
sahealth.sa.gov.au/wps/wcm/connect/149020804eedac35b186b36a7ac0d6e4/Puerperal-genital-haematomas-WCHN-PPG-22052013.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-149020804eedac35b186b36a7ac0d6e4-lNuWuA-
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

Share this article

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

Consequences of birth cephalohematoma in the future – important information for parents – clinic “Dobrobut”

Main

Medical Library Dobrobut
Publication date: 2020-01-22

Cephalohematoma in newborns on the head – symptoms, treatment

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 an 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 recommend using Troxerutin to speed up 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 deformity of the skull bones.

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

Related services:

Pediatric consultation
Breastfeeding, its role in a child’s life

Do you want to get an online explanation from the doctor of the Dobrobut MS?

Download our Google Play App and App Store

Our Doctors

See all doctors 786

Our certificates

Certificate no. QIZ 804 468 C1

Certificate no. QIZ 804 469 C1

Certificate No. QIZ 804 470 C1

Certificate no. QIZ 804 471 C1

View all certificates

Request a call back

Enter your phone number

Retrochorial hematoma. Part 1. Causes and classifications of hematomas

Retrochorial or intrauterine hematoma is one of the most common causes of bleeding in the 1st and 2nd trimesters of pregnancy and an absolute indication for an urgent consultation with an obstetrician-gynecologist and, possibly, hospitalization!

What is an intrauterine hematoma? Why is it formed? What are the types of hematomas? What are the consequences of a hematoma and how to act if a hematoma is detected?

So, intrauterine hematoma is formed as a result of partial detachment of the membrane of the fetal egg (chorionic plate) from the underlying decidua (the inner lining of the uterine wall), manifested by the accumulation of blood in the retrochorial space and is detected by ultrasound in 4-22% of pregnant women.

The reason for the formation of a hematoma is associated with a violation of the processes of invasion of the trophoblast (formation of the future placenta):

1) penetration of trophoblast cells occurs more superficially than during normal implantation,

2) Angiogenesis processes are disrupted (vessels in the future placenta form very fragile, defective, easily damaged and bleed),

3) Inadequate migration of endovascular (intravascular) trophoblast prevents the formation of the so-called “plug” in the lumen of the spiral arteries, which also predisposes them to increased bleeding.

The causes of violations of implantation processes can be both factors leading to habitual miscarriage (these are genetic thrombophilias, APS, immunological factors unrelated to APS, chronic endometritis, HLA compatibility, infections, etc.), and the causes of sporadic (spontaneous) miscarriages associated with a chromosomal abnormality of the embryo. In fact, the mechanism of pregnancy rejection is the same for both habitual and sporadic miscarriage, based on the formation of an inferior trophoblast, incapable of normal invasion.

However, none of us until 10-12 weeks of pregnancy (until the result of a non-invasive prenatal test is obtained) cannot know the exact cause of the detachment of the fetal egg: this is a natural selection mechanism due to a chromosomal abnormality or there are some reasons in the body of the pregnant woman herself for the rejection of the embryo. Therefore, a priori, we treat each pregnancy as a pregnancy with a normal karyotype of the embryo and, accordingly, we do everything to save it. In 80-90% of cases, it is not possible to save an embryo with a chromosomal abnormality, the remaining 10-20% of probable chromosomal pathology are detected as part of prenatal screening and NIPT (non-invasive prenatal test).

Today, the policy of “non-intervention” in patients with intrauterine hematomas, based on the idea of natural selection, has been radically revised. This is primarily due to the emergence of indisputable evidence of an increase in 2 or more times the risk of serious pregnancy complications in the event of hematomas. Minimizing these complications is possible only with an immediate response to various therapeutic measures, without waiting for the truth on the chromosome set of the embryo!

The development of preeclampsia, intrauterine fetal growth retardation, premature birth, miscarriage can be associated both with the causes themselves that led to the formation of a hematoma (disturbance of the processes of trophoblast invasion), and with the consequences of the occurrence of a hematoma (the appearance of oxygenated blood in the subchorionic space, leading to oxidative stress and impaired development of the placenta; initiation of inflammation processes by blood decay products; progression of separation of the chorion / placenta / obol points from the wall of the uterus, culminating in the process of expulsion).

Of great prognostic value is the time of occurrence of a hematoma (the risk of adverse outcomes increases by 2.4 times with hematomas that occurred before 9 weeks), the size of the hematoma, which is defined as% detachment in relation to the size of the entire fetal sac (up to 20% – small hematomas, 20-50% – medium, more than 50% – large), the duration of the hematoma. The prognosis is not significantly affected by the localization of the hematoma relative to the walls of the uterus (detachment along the anterior, posterior walls, in the bottom, above the internal os).

There are 4 main types of intrauterine hematomas:

1. Retrochorial (subchorial) are also called marginal (marginal) – located between the chorionic plate and the wall of the uterus and account for 80% of all hematomas.

2. Retroplacental hematomas – located between the placenta and myometrium (16%).

As a rule, in everyday practice we deal with these two types of hematomas.

3. Subamniotic (preplacental) – between the amniotic membrane and the placenta (4%). It is formed as a result of rupture of the branches of the vessels of the umbilical cord, as a rule, during traction of the umbilical cord in the 3rd stage of labor or active movements of the fetus in the 3rd trimester of pregnancy, which in some cases can lead to feto-maternal shedding of blood and anemia in the fetus.