Postpartum spontaneous vulvar hematoma is a rare complication during childbirth that causes maternal death if mismanaged.
This case is of a 28-year-old para IV mother who gave birth to an alive female neonate. Her weight was 3000 g at home, twenty-four hours before presenting to the hospital. She could not recall her last period and claimed to have been amenorrheic for nine months and had ANC care. The patient was to visit a health centre when she experiences labour pains but her labour onset was within six hours. Hence, she gave birth at home. The mother reported that it was a normal traditional birth with no complications. Moreover, there was no noticeable excessive bleeding. However, she did notice gradual swelling of the placenta for which she rushed to the nearby hospital with her family. Doctors evaluated the vulvar hematoma and referred her to another hospital for a transfusion of blood.
Upon consultation by the physician and gynaecologist, the mother reported vaginal bleeding from the vulva on her way, noticeable swelling of the vulva, and vulvar pain. In addition, she had micturition difficulty. She also complained of palpitation, vertigo, fatigue, and headache. However, she had no medical history of diabetes, hypertension, and bleeding tendency. Furthermore, she looked acutely sick, with a dry buccal mucosa and pale conjunctivae. Her abdominal examination revealed a well-contracted, non-tender, twenty-week-sized uterus. Moreover, her bladder showed distention. No signs of fluid retention and organomegaly were seen.
Genital examination showed a mass on the right side, extending to the mon pubis and to the right buttock posteriorly. In addition, the mass was fluctuant and tender, with two stitches. She also exhibited palmar pallor; however, no vaginal bleeding was seen.
Final Diagnosis – Postpartum Spontanous Vulvar Hematoma
Doctors made a final diagnosis of severe anaemia due to postpartum haemorrhage secondary to a vulvar hematoma. They admitted her to the obstetric wards and surgically managed her, discharging her and the newborn on the fourth day of the procedure.
Neglect in the management of postpartum vulvar hematoma cause maternal morbidity. Hence, timely surgical exploration, ligation, and obliteration of the dead space are necessary for the management of the complications.