Post-Partum Vulva Hematoma Management in a Low Resource Setting : A Case Report

Abstract

Large postpartum vulvar hematoma is a rare post-obstetric complication and its prompt recognition can help reduce the risk of maternal death. Only few cases have been reported and currently there is no standard consensus existing on the best management of vulvar hematomas. Herein, we report the successful management of a large post-obstetric vulvar hematoma through a simple incision in a low resource setting in government hospital in Isiokolo, Delta State Nigeria. We report the case of a 20-year-old booked now para I mother from rural delta state who presented with vulvar pain and rapidly expanding spontaneous vulvar hematoma in the right labium majus. On admission, the young woman had essentially normal blood work. An incision was made in the right labium majus under local anesthesia followed by surgical drainage and evacuation of clot and ligation of the bleeding points. The patients’ clinical symptoms progressively improved and their was no hemorrhagic recurrence until hospital discharge forty eight hours later.  Good inspection of the vulva and perineum post-delivery remains pivotal in vulva hematoma prevention Once detected   the hematoma must be immediately assessed whether or not it is   localized and surrounding pelvic structures must be evaluated as these factors will determine the treatment modality. In low resource settings where hematoma is confirmed to be localized with no damage to surrounding pelvic structures and patients are hemodynamically stable a simple incision to drain the hematoma with ligation of bleeding vessels under local anesthesia can be performed to relieve the pain, prevent pressure necrosis and reduce morbidities.