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

Abstract

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

Large Vaginal Hematoma in a Puerperium Patient: Treating a Delayed Diagnosis & Management Caused by an Incomplete Clinical Examination

“…Causes of vulvovaginal hematomas include spontaneous or iatrogenic injury to blood vessels (branches of the internal pudendal artery), pseudoaneurysm, or traumatic arteriovenous fistula [ 3 ]. Risk factors include nulliparity, precipitate labor, macrosomic babies, prolonged second-stage labor, instrumental vaginal deliveries like forceps delivery or ventouse delivery, poorly repaired lacerations or episiotomies, hypertensive disorders of pregnancies, coagulopathy or vulvar varicosities [ 1 , 3 , 4 ]. In our case, a history of prolonged second-stage labor and a macrosomic baby was present.…”

“…Management of vulvovaginal hematomas depends on the size of the hematoma, the hemodynamic stability of the patient, and available medical facilities [ 3 ]. Conservative management can be done for small non-expanding and asymptomatic hematomas including sitz baths, ice packs, antibiotics, analgesics, and blood transfusion if required [ 3 ]. Large or expanding hematomas are managed surgically either by exploration or by arterial embolization [ 3 ].…”

“…Conservative management can be done for small non-expanding and asymptomatic hematomas including sitz baths, ice packs, antibiotics, analgesics, and blood transfusion if required [ 3 ]. Large or expanding hematomas are managed surgically either by exploration or by arterial embolization [ 3 ]. Surgical exploration consists of incision and drainage, ligating bleeding vessels, obliterating all dead spaces, achieving hemostasis, and placing a drainage tube or vaginal pack [ 3 ].…”

“…Large or expanding hematomas are managed surgically either by exploration or by arterial embolization [ 3 ]. Surgical exploration consists of incision and drainage, ligating bleeding vessels, obliterating all dead spaces, achieving hemostasis, and placing a drainage tube or vaginal pack [ 3 ]. This is what was done for our patient.…”

“…Vulvo-vaginal hematomas are not commonly encountered in obstetrical practice but if not managed correctly, can be life-threatening with serious maternal morbidity and cause maternal near-miss cases [1]. They can be managed by different treatment methods which include watchful observation, surgical drainage, ligation or angiographic embolization of bleeding vessels, packing, hysterectomy, and internal iliac artery ligation [1][2][3]. The correct management in a particular case depends on the experienced judgment and decision of the treating clinician based on the patient's hemodynamic stability, the size of the hematoma, its expansion, and the presenting symptoms [3].…”