In plain words
A vulvar hematoma is a collection of blood in the tissue next to the vagina or vulva. It usually forms after a vaginal birth, when a small blood vessel tears inside the tissue. It is less common than other birth injuries. Mothers often describe severe, constant pressure in the or rectum, sometimes on one side, that seems out of proportion to the tear they can see. A hematoma can be treated, and many resolve on their own. Severe or worsening pain, a swelling that keeps growing, dizziness, or heavy bleeding needs prompt care, so call your provider today or go in now.
The deeper version
Vulvar and paravaginal hematomas result from bleeding into the perineal or paravaginal space, most often from a branch of the pudendal or vaginal arteries torn during delivery, with risk raised by operative vaginal delivery, a long , and . Incidence is low and estimates vary widely, partly because small collections go unrecognized. Presentation is severe, unilateral or diffuse perineal or rectal pressure out of proportion to visible trauma, sometimes with a palpable mass. Management ranges from observation and analgesia for small collections to evacuation, packing, or angiographic embolization for large or expanding ones (Cunningham et al., Williams Obstetrics, 26th edition, 2022; ACOG Practice Bulletin 198, 2018). The distinction from other post-delivery pain sources is clinically important and is often made by imaging.
Where it comes up
- Healing a tear or stitchesPostpartum: Your Body
- Afterpains: cramping while nursingPostpartum: Your Body
- Postpartum bleeding (lochia): what's normal, what's notPostpartum: Your Body
- Postpartum warning signs: the one-page listPostpartum: Your Body
What mothers here say about vulvar hematoma
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Sources
- Cunningham FG et al. — Williams Obstetrics, 26th edition, 2022
- American College of Obstetricians and Gynecologists — Practice Bulletin 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery, 2018
- Royal College of Obstetricians and Gynaecologists — Green-top Guideline No. 37a: Good Practice in Postpartum Care, 2015