Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
Description
Introduction:
Vulvar hematoma is a collection of blood in the soft tissue called the vulva. Branches of the pudendal artery supply the smooth muscle and loose connective tissue. Vulvar hematomas are a common obstetric complication, but they can occur in non-obstetric settings as well due to trauma. During the birthing process, direct injuries, such as episiotomy, vaginal laceration repairs, or instrumental deliveries, and indirect injuries, such as extensive stretching of the birth canal during vaginal delivery, can lead to vulvar hematoma formation. Risk factors for vulvar hematoma formation include episiotomy, prolonged second stage of labor, macrosomia, anticoagulants, hypertensive disorders of pregnancy, primiparity, and instrumental deliveries. Patients typically present with a swollen fluctuant mass that can be extremely tender to palpation within hours to days of delivery. Most cases are managed conservatively; however, once the hematoma is larger than 10 cm or causing urological symptoms, surgical intervention is warranted. Early recognition of vulvar hematoma is of importance to reduce morbidity and improve patient outcome.
Case Presentation:
An 18-year-old female, G1P1001, status post normal spontaneous vaginal delivery complicated by gestational hypertension presents with an expanding and painful vulvar hematoma an hour after delivery associated with inability to void. Delivery augmentation included cook balloon, Pitocin, and rupture of membranes. First degree laceration repaired with 2-0 vicryl and bilateral labial lacerations repaired with 4-0 vicryl with a noted estimated blood loss of 100cc. Significant swelling of the labia noted on physical exam and patient unable to void into bedpan. A STAT pelvic ultrasound ordered with official radiology findings of complex labial region mass measuring 6.4 x 4.5 cm and suspect large complex hematoma. The perineum reassessed after successful placement of foley catheter with ice packs but swelling noted to continue. Decision made to proceed to the operating room for evacuation of the vulvar hematoma and cystoscopy due to the close proximity of the hematoma to the bladder. Intraoperative findings include significantly enlarged, edematous right labia with minimally edematous left labia causing significant pain and inability to void. The right labia contained approximately 300cc blood clots which were removed. Ischiocavernosus and bulbocavernosus muscles shredded and required reapproximation. During cystoscopy, bladder noted to be free of any masses, lesions, trauma, and suture with bilateral ureteral jets patent. Clots from the uterus removed and noted to be boggy. Methergine IM administered including tranexamic acid and rectal Cytotec with noted improved uterine tone. The patient was sent to recovery in stable condition with transfusion of two packed red blood cells due to significant blood loss.
Conclusion:
This case presents a common obstetric complication, a vulvar hematoma, with a good prognosis if recognized early with prompt intervention. If left unnoticed, there is increased risk of morbidity such as hemodynamic instability, anemia, infection, and hemorrhage. While most cases are managed conservatively with ice packs, local compressions, bed rest, and analgesics, expanding hematomas with urinary symptoms are managed surgically via evacuation of blood clots and ligating any bleeding arteries. When promptly recognized, patients have excellent outcomes.
Embargo Period
5-29-2026
Included in
Postpartum Vulvar Hematoma: A Common Obstetric Complication
Moultrie, GA
Introduction:
Vulvar hematoma is a collection of blood in the soft tissue called the vulva. Branches of the pudendal artery supply the smooth muscle and loose connective tissue. Vulvar hematomas are a common obstetric complication, but they can occur in non-obstetric settings as well due to trauma. During the birthing process, direct injuries, such as episiotomy, vaginal laceration repairs, or instrumental deliveries, and indirect injuries, such as extensive stretching of the birth canal during vaginal delivery, can lead to vulvar hematoma formation. Risk factors for vulvar hematoma formation include episiotomy, prolonged second stage of labor, macrosomia, anticoagulants, hypertensive disorders of pregnancy, primiparity, and instrumental deliveries. Patients typically present with a swollen fluctuant mass that can be extremely tender to palpation within hours to days of delivery. Most cases are managed conservatively; however, once the hematoma is larger than 10 cm or causing urological symptoms, surgical intervention is warranted. Early recognition of vulvar hematoma is of importance to reduce morbidity and improve patient outcome.
Case Presentation:
An 18-year-old female, G1P1001, status post normal spontaneous vaginal delivery complicated by gestational hypertension presents with an expanding and painful vulvar hematoma an hour after delivery associated with inability to void. Delivery augmentation included cook balloon, Pitocin, and rupture of membranes. First degree laceration repaired with 2-0 vicryl and bilateral labial lacerations repaired with 4-0 vicryl with a noted estimated blood loss of 100cc. Significant swelling of the labia noted on physical exam and patient unable to void into bedpan. A STAT pelvic ultrasound ordered with official radiology findings of complex labial region mass measuring 6.4 x 4.5 cm and suspect large complex hematoma. The perineum reassessed after successful placement of foley catheter with ice packs but swelling noted to continue. Decision made to proceed to the operating room for evacuation of the vulvar hematoma and cystoscopy due to the close proximity of the hematoma to the bladder. Intraoperative findings include significantly enlarged, edematous right labia with minimally edematous left labia causing significant pain and inability to void. The right labia contained approximately 300cc blood clots which were removed. Ischiocavernosus and bulbocavernosus muscles shredded and required reapproximation. During cystoscopy, bladder noted to be free of any masses, lesions, trauma, and suture with bilateral ureteral jets patent. Clots from the uterus removed and noted to be boggy. Methergine IM administered including tranexamic acid and rectal Cytotec with noted improved uterine tone. The patient was sent to recovery in stable condition with transfusion of two packed red blood cells due to significant blood loss.
Conclusion:
This case presents a common obstetric complication, a vulvar hematoma, with a good prognosis if recognized early with prompt intervention. If left unnoticed, there is increased risk of morbidity such as hemodynamic instability, anemia, infection, and hemorrhage. While most cases are managed conservatively with ice packs, local compressions, bed rest, and analgesics, expanding hematomas with urinary symptoms are managed surgically via evacuation of blood clots and ligating any bleeding arteries. When promptly recognized, patients have excellent outcomes.
Comments
Presented by Allison Tresner.