Vulvovaginal haematoma presenting in the puerperium: A case report

Background: Vulvovaginal haematoma is an uncommon complication of childbirth that can cause maternal death if not properly managed. We present a case of a large vulvovaginal haematoma managed surgically with a good outcome.

Clinical Presentation: JP was an unbooked 34 year old para 2 woman referred from a maternity home to Bethesda Family Hospital on account of a left-sided vulva swelling of two weeks duration following a spontaneous vaginal delivery of a live male baby that weighed 4.3 kilogrammes. She sustained a vaginal tear which was repaired by the attending midwife. Vaginal examination showed a firm and tender swelling of size 12 cm by 14cm involving the left labia majora and minora and extending to the perineal region and vagina. A diagnosis of vulvovaginal haematoma was made and she was educated on her condition and the treatment options. She was haemodynamically stable and the full blood count was normal. She was placed on analgesics and antibiotics, catheterized, and the haematoma evacuated under ketamine cover. She was discharged home on the second day.

Conclusion: Surgical management of large vulva haematoma at the primary care level involves counselling, institution of antibiotics and analgesics and appropriately located incisions and evacuation of clots. This leads to quick recovery with minimal scarring, pain and dyspareunia.