International Journal of Medical Science and Pharmaceutical Research

Background: Postpartum vulvar hematoma is an uncommon but potentially life-threatening complication of vaginal delivery that can result in significant blood loss, hemorrhagic shock, and maternal morbidity. Prompt recognition and appropriate intervention are essential for a favorable outcome.

We report the case of a prim gravida who developed a massive vulvar hematoma following vaginal delivery at a primary healthcare facility. She was referred to a tertiary healthcare facility in hemorrhagic shock. Clinical assessment revealed severe anemia, with a packed cell volume of 14%. Emergency resuscitation was initiated, followed by surgical exploration of the hematoma and blood transfusion. The patient responded favorably to treatment and was discharged home on the fourth day of admission.

Conclusion: Massive postpartum vulvar hematoma can cause life-threatening hemorrhage following vaginal delivery. Early recognition, prompt referral, adequate resuscitation, blood transfusion, and timely surgical intervention are essential to achieving favorable maternal outcomes.

Postpartum hemorrhage; vulvar hematoma; hemorrhagic shock; vaginal delivery; blood transfusion; emergency obstetric care. Delivery at a primary health care facility.

1. Tilahun T, Wakgari A, Legesse A, Oljira R. Postpartum spontaneous vulvar hematoma as a cause of maternal near miss: a case report and review of the literature. J Med Case Rep. 2022; 16:85. Doi: 10.1186/s13256-022-03281-2.
2. Oong GC, Eruo FU. Vulvar hematoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
3. Anass E, et al. Post-partum hemorrhagic shock following puerperal hematoma. PAMJ Clin Med. 2020; 3:43. doi:10.11604/pamj-cm.2020.3.43.2310.
4. Takahashi H, et al. managing vulvovaginal hematoma by arterial embolization as first-line hemostatic therapy. Taiwan J Obstet Gynecol. 2017; 56(2):224-6. doi:10.1016/j.tjog.2017.02.004.
5. Tseng JY, Lin IC, Lin JH, Chang CM, Chao WT, Wang PH. Optimal approach for management of postpartum vulva hematoma: report of three cases. Taiwan J Obstet Gynecol. 2020; 59(5):780-3. doi:10.1016/j.tjog.2020.07.030.
6. Heffner LJ, Mennuti MT, Rudoff JC, McLean GK. Primary management of postpartum vulvovaginal hematomas by angiographic embolization. Am J Perinatol. 1985; 2(3):204-7. Doi: 10.1055/s-2007-999949.
7. Onyeodi I, Izah A, Ukpeteru F. Post-partum vulva hematoma management in a low resource setting: a case report. Trop J Obstet Gynaecol. 2024.
8. Bienstman-Pailleux J, Huissoud C, Dubernard G, Rudigoz RC. Management of puerperal hematomas. J Gynecol Obstet Biol Reprod (Paris). 2009; 38(3):203-8. doi:10.1016/j.jgyn.2008.10.002.
9. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012.
10. American College of Obstetricians and Gynecologists. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol. 2017; 130(4):e168-86.
11. Heffner LJ, Mennuti MT, Rudoff JC, McLean GK. Primary management of postpartum vulvovaginal hematomas by angiographic embolization. Am J Perinatol. 1985; 2(3):204-7. Doi: 10.1055/s-2007-999949.
12. Winkelman J, Murphy K, Booth C. Delayed presentation of a non-resorbing postpartum vulvar hematoma: a case report. Case Rep Womens Health. 2023; 38:e00518. doi:10.1016/j.crwh.2023.e00518.
13. Postpartum angiographic embolization for vulvovaginal hematoma: a report of two cases. PubMed. 2001. PMID: 11209635.
14. American College of Obstetricians and Gynecologists. Practice bulletin No. 183: postpartum hemorrhage. Obstet Gynecol. 2017; 130(4):e168-86.
15. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012.