Analysis of puerperal hematoma: a retrospective study

Abstract

Objective: To evaluate the characteristics and risk factors of puerperal hematoma. Materials and Methods: Data from the medical records of 2,776 women, who delivered vaginally between January 2008 and December 2017 in the authors’ hospital, were analyzed retrospectively. Results: Primigravida status was considered to be a significant risk factor. Among women with multigravida status, maternal age, instrumental delivery, and episiotomy were considered to be statistically significant risk factors. Regarding characteristics, hematoma occurred on the right side in 61.5% of cases, 53.8% were ≥50 mm in size, 61.5% were detected within 2 h of delivery, 46.2% were associated with severe pain, and 61.5% required surgical treatment. Conclusion: Primigravida status a risk factor for puerperal hematoma, and maternal age, instrumental delivery, and episiotomy were risk factors for puerperal hematoma in women with multigravida status. Puerperal hematomas occurred more frequently on the right side than the left reflected by the number of episiotomies performed on the right side. Approximately one-half of the hematomas were associated with severe pain, and many were detected within 2 h after delivery. Many hematomas, especially those associated with severe pain, required surgical removal.

Delayed presentation of a non-resorbing postpartum vulvar hematoma: A case report

“…The median time to detect formation of a hematoma is 6 h postpartum [ 6 ], while the most common presenting sign of a hematoma is pain within 24 h of delivery [ 2 , 3 ]. One retrospective study found that 46.2% of puerperal hematomas were associated with severe pain, and 61.5% of the hematomas were detected within 2 h of delivery [ 7 ]; 61.5% of cases had the hematoma on the right side [ 7 ]. Delayed detection of a vascular injury could be due to pressure necrosis, while immediate detection is seen with direct vessel injury [ 8 ].…”

“…Conservative management involves minimal additional treatment measures [ 15 ]. One retrospective study found that 53.8% of hematomas were ≥ 5 cm in size [ 7 ]. In contrast, larger (>12 cm) hematomas, continuously expanding hematomas, or those large enough to cause either urologic or neurologic symptoms may require management with surgical exploration or vessel ablation through interventional radiology.…”

“…In contrast, larger (>12 cm) hematomas, continuously expanding hematomas, or those large enough to cause either urologic or neurologic symptoms may require management with surgical exploration or vessel ablation through interventional radiology. One retrospective study found that 61.5% of detected hematomas required surgical treatment [ 7 ]. In the majority of cases, evacuation, drainage and ligation of bleeding vessels are sufficient to achieve hemostasis [ 15 ].…”

Conservative Management of Retroperitoneal Hematoma Expanded to Prerenal Space Due to Episiotomy in a Woman with Vaginal Delivery, a case report

“…[ 5 ]. Hematoma in the episiotomy site is another uncommon complication due to episiotomy [ 6 , 7 ]. Also, it could be more common and expanded in patients with underlying diseases, such as coagulation disorders [ 8 ].…”

Risk factors and management of perinatal genital hematoma: A single, tertiary medical center retrospective study in China

“…Puerperal genital hematoma (PGHA) is an infrequent but a serious obstetrical complication associated with delivery. Over the previous decade, the incidence of PGHA has been documented to range from around 1 in 1500 to 1 in 210 1–3 …”