Collection of blood anywhere in the vulvar region is called vulvar hematoma. Although vulvar haematomas can occur after an injury to the vulva due to any cause, it is commonly seen after the vaginal delivery of a baby.
A Vulvar hematoma can occur either spontaneously or after improper repair of an episiotomy wound. Blood from the rupture of the deep veins of this region collects in a closed space with no opening for it to drain out. The collected blood causes the area to swell with severe pain.
Vulvar hematomas are more common with instrumental deliveries like Forceps deliveries or vaccum aspirations - forceps deliveries being more risky.
An episiotomy decreases the risks of a vulvar hematoma by increasing the size of the opening of the vagina.
But hematomas can also occur even after an episiotomy has been done, if the blood vessels has not been adequately ligated during the repair.
Symptoms of Vulval Hematoma
- A steadily increasing swelling to one side of the vagina.
- The swelling is tense and tender to the touch.
- The collected blood may cause the swelling to be purplish or blackish in color.
- The woman complains of severe pain, more so on sitting down. The pain is unrelieved with painkillers.
- There may be difficulty in passing urine if the swelling presses on the urethra.
- Rectal pressure can occur.
- The bleeding can be severe enough to cause the patient to go into hemorrhagic shock.
Treatment / Management of Vulval Hematoma
The aim of treatment is to ligate the bleeding blood vessels as early as possible and support the patient with IV drips and medicines so that she does not go into shock.
- An incision is made at the most distended point of the hematoma.
- The incision is then deepened and the blood clots scooped out.
- The bleeding vessels are identified and tied up.
- The incision is closed by applying different layers of stitches.
- A drain may be put in the wound for 24 hours to allow any oozing blood to flow out.
- Proper antibiotics are prescribed and the patient kept under close observation.
- Blood transfusion is given if necessary.