An obstetric emergency case: vulvovaginal hematoma – our four-year results

Objective: Vulvovaginal hematomas after vaginal delivery are rare but among the life-threatening complications. Though hematomas are related with episiotomy or operative delivery, those may occur in the absence of incision or laceration due to pseudoaneurysm or traumatic arteriovenous fistula. Methods: Demographic and obstetric data, symptom and examination findings, hematologic and biochemical parameters and findings of 52 vaginal deliveries without vaginal hematoma were compared in 52 cases who were intervened due to vulvovaginal hematoma between 2010 and 2013 at Zekai Tahir Burak Maternal Health Training and Research Hospital. Cost analyses were calculated by reviewing delivery room work periods, compliance with personnel and relationship with shifts. Results: In a total of 31,163 vaginal deliveries, incidence of vulvovaginal hematoma was found to be 0.16% with 52 cases that were all infralevator. Moreover, all patients with vulvovaginal hematoma had pharmacological induction, 37 of the women were delivered with episiotomy and 13 women (23%) had compliance problem with personnel during labor and delivery. The initial symptoms of the developing hematoma were pain in vulva and perineal region. Hematoma was detected in 31 patients (59.6%) within the first 6 hours after delivery. Transfusion was needed in 37 patients (71.2%) and 35 of them (96.2%) were applied two and more erythrocyte suspension transfusion. It was understood from the medical records that it was tried to determine bleeding focus by opening hematoma area in all cases during general anesthesia, and laparotomy was performed afterwards in one patient. Hospital cost and duration of hospitalization were found to be increased significantly. Conclusion: Early diagnosis of vulvovaginal hematoma is established by meticulous check of birth canal during delivery and by a meticulous examination again immediately in vulvar and perineal pain complains after delivery. Labor induction should be practiced in absolute indications.