Large Vulva Haematoma Following Spontaneous Vaginal Delivery: Successful Conservative Management in Enugu, South East Nigeria

Nnaji, Henry C; Nwankwo, Theophilis O.; Aniebue, UU; Asogwa, Augustine O.

doi:10.4236/arsci.2020.81003

Cited by 1 publication

(2 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Awoleke et al presented a case of vulvovaginal infra-levator hematoma mimicking the second stage of labor with persistent painful bearing down efforts even after successful delivery of the baby, which was managed surgically [ 1 ]. Nnaji et al reported a case of vulval hematoma of 12cm×10cm following spontaneous vaginal delivery that was managed conservatively [ 4 ]. Tseng et al reported three cases of vaginal hematoma; first, of an increasing hematoma of 12cm size on day two of puerperium, second with an impending rupture, and a third postpartum bilateral hematoma; all were managed by debridement and arterial embolization [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sinha¹,

Agarwal²,

Singh³

2023

Cureus

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Here, we report a case where the lack of pelvic examination in a puerperium patient led to a delay in diagnosis and appropriate management of a large posterior vaginal wall hematoma for about a month. The patient had a history of difficult vaginal breech delivery of a macrosomic asphyxiated baby 28 days prior, following which, she started having gradually increasing distension of the abdomen, inability to void urine and pass stools by herself, and a history of fever on and off. Her family members took her to a private hospital for a consultation, where she was examined and assessed. However, a pelvic examination was not done. A CT scan of the abdomen and pelvis showed a large organized hematoma of size 13.6cm×11.1cm×10.5cm with a volume of 802 ml in the pouch of Douglas. Following this report, diagnostic laparoscopy was done on day 10 of puerperium where a large hematoma was seen beneath the peritoneum in the pouch of Douglas without any intraperitoneal collection. As the hematoma was not seen to be expanding, conservative management was done with 5 units of blood transfusion and antibiotic coverage, and the patient was discharged. However, the patient's symptoms were not relieved due to which she presented to us on day 28 of puerperium with the same symptoms. On pelvic examination, purulent, foulsmelling discharge was present in the vagina, and a huge tense bluish bulge was seen in the posterior vaginal wall more towards the right side obliterating the whole vagina. After taking informed consent and with proper pre-operative preparations of laparotomy, the hematoma was drained vaginally, and approximately 1300 ml of blood and clots were removed, following which, the patient had a speedy recovery and relief of her symptoms.

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