Exxcellence pearls: hematoma after vacuum delivery

Question 1

What are risk factors for puerperal hematomas?

Answer 1

Operative vaginal delivery, nulliparity, preeclampsia, coagulation disorders, multiple gestation, improper surgical repair episiotomy

Question 2

What vessels are usually injured in hematoma formation in the anterior triangle?

Posterior triangle?

Answer 2

Branches of the internal pudendal artery

Inferior rectal artery

Question 3

How should non-expanding hematomas be managed?

Answer 3

Conservative measures such as ice packs, observation, pain management and bladder drainage.

Question 3

Rupture of the descending branches of the uterine artery can cause hematoma in what location?

Answer 3

Paravaginal

Question 4

What locations should be evaluated for extension of hematoma?

How should they be evaluated?

Answer 4

Vulva, vagina, retroperitoneal space or abdominal cavity.

Physical exam. Imaging may be necessary if exam is insufficient.

Question 5

How should expanding hematomas or concealed hemorrhage be managed?

Answer 5

Prophylactic antibiotics, hematoma evacuation, identification and ligation of bleeding vessel, repair of the cavitary defect. Artery embolization has been used as well when bleeding is not controlled by conventional surgical techniques.