Everything You Need to Know About Vaginal Hematomas

Vaginal Hematomas: What Are They?

A vaginal hematocele (vHem) is a condition where blood does not drain from one or both sides of the womb during childbirth. A woman with a vHem may experience bleeding after giving birth, but it usually stops within a few days. However, if she experiences prolonged bleeding, her risk of developing life threatening complications increases significantly. If left untreated, the condition can lead to infection and even death.

The term “hematoceles” refers to the abnormal growths that form inside the uterus, which are called hematoscopic masses. These masses are made up of blood vessels and other tissue, such as bone marrow. They can grow very large and cause severe bleeding problems. Hematocrit (the percentage of red blood cells in your body) plays a role in how much blood drains from these masses. Women with high hematocrit have higher levels of blood flow to their uteri, which allows them to bleed less than women with low hematocrit.

How Common Is Vulvar Hematoma?

According to the American College of Obstetricians and Gynecologists (ACOG), approximately 1 out of every 3,000 births results in a vHem. Most cases occur before age 20 years.

Hematomas most often develop in the lower part of the uterus, behind the placenta. They can also start in the uterine artery, which is located near the top of the uterus. An injury during birth may damage one or both of these areas.

What Are the Symptoms of a Vaginal Hematoma?

A vHem causes serious complications in some women. The symptoms can include:

Vaginal bleeding after giving birth

Pain or tenderness in the lower abdomen, including the lower back and groin

Abdominal fullness (typical of a swollen abdomen)

A bulge or mass that can be seen or felt during a physical exam

How Is a Vaginal Hematoma Diagnosed?

A health care provider diagnoses a vHem through a pelvic exam. During the exam, he or she will use one finger to push up on the cervix in order to push any enlarged blood vessels downward. A transvaginal ultrasound can also help identify enlarged blood vessels.

An abdominal ultrasound can help rule out other causes of a swollen abdomen, such as an ovarian cyst or other reproductive organ problem. A complete blood count (CBC) can assess the extent of blood loss and the patient’s overall risk for anemia (low red blood cell count).

How Is a Vaginal Hematoma Treated?

Most vHems are not treated with surgery right away because the bleeding is often minor. The patient may receive a blood transfusion if her hematocrit is low. In some cases, the bleeding stops on its own within a few days.

If the bleeding continues or worsens, the health care provider may perform a dilation and curettage (D&C) procedure to remove the vHem. The patient receives anesthesia and is put to sleep for this minor surgical procedure. A small incision is made into the vHem to drain it. The health care provider then uses a curette to gently scrape the area and remove as much blood as possible. The patient may require stitches and/or pain medication.

If the vHem recurs or is severe, the health care provider may perform a hysterectomy. This surgical procedure removes the uterus.

How Can a Vaginal Hematoma Be Prevented?

There are no known ways to prevent vHems, but there are things that can be done to decrease the risk of complications.

Pregnant women who experience a vaginal bleeding incident of any kind following birth should seek immediate medical attention. A health care provider can assess if the incident is a vHem or another type of problem, such as an injury.

The American College of Obstetricians and Gynecologists (ACOG) recommends that periodic assessments be done on women who experience a postpartum hemorrhage of any kind. This can help identify women at risk for vHems.

A woman who has delivered one child vaginally and experiences a postpartum hemorrhage is at higher risk for a second delivery vaginally. A woman who has had two or more c-sections is also at higher risk. The health care provider may recommend a c-section to decrease the risk of complications during future deliveries.

Sources:

ACOG Practice Bulletin. Number 104: Obstetric Surgery. (Obstetrics & Gynecology) July 2008. American College of Obstetricians and Gynecologists (ACOG).

Bleeding Disorders In Pregnancy. (NORD Guide). National Organization for Rare Disorders (NORD). April, 2008.

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