Vulval Haematoma

Subject: Midwifery III (Theory)

Overview

Vulval haematoma is a subtype of pelvic haematoma. Pelvic haematoma is a collection of blood anywhere between the pelvic peritoneum and the perineal skin. Vulval haematomas are caused by improper homoeostasis during repair of vaginal or perineal tears or episiotomy wounds, failure to take precautions while suturing the apex of the tear, failure to obliterate the dead space while suturing the vaginal wall, and rupture of the para vaginal venous plexus either spontaneously or after instrumental delivery. Local examination indicates a tight enlargement at the vulva that turns dusky and purple in color. Under GA, investigate the haematoma using aseptic precautions. Give the prescribed antibiotics on schedule and explain to the mother when and how to take them.

Vulval haematoma is a subtype of pelvic haematoma.

Pelvic haematoma: A pelvic haematoma is an accumulation of blood anywhere between the pelvic peritoneum and the perineal skin.

Anatomical types: Depending on whether the haematoma is below or above the levator ani, it is referred to as:

Inftalevator haematoma - common (vulval haematoma)
Supra levator haematoma - rare

Causes

Improper homoeostasis during vaginal or perineal tear repair or episiotomy wound closure.
Failure to take care when suturing the tear's apex.
Failure to remove the dead space before suturing the vaginal walls.
Paravaginal venous plexus rupture, either spontaneously or as a result of instrumental delivery.

Sign and symptoms

Symptoms

The mother reports chronic, intense pain in the perineum.
When the ischiorectal fossa is extended, there may be rectal tenesmus or bearing down effort.
Urine retention is possible.

Signs

Local inspection indicates a tight swelling at the vulva that darkens and turns purple.
Shock in varying degrees may be visible.

Management

Good management should begin in the third or fourth stage of labour.
A haematoma should be discovered as soon as possible.
Under GA, investigate the haematoma while taking aseptic precautions.
Perineal care should be performed every four hours, and the wet pad should be changed as needed.
Explain to the mother the importance of hygiene and ambulation.
Give the antibiotics on schedule and explain to the mother when and how to take them.

Things to remember

Vulval haematoma is a subtype of pelvic haematoma, so it was introduced first.
Pelvic haematoma is defined as a collection of blood somewhere between the pelvic peritoneum and the perineal skin.
Improper homoeostasis during repair of vaginal or perineal tears or episiotomy wound, failure to take precautions while suturing the apex of the tear, failure to obliterate the dead space while suturing the vaginal wall, and rupture of the para vaginal venous plexus either spontaneously or following instrumental delivery are the causes of vulval haematoma.
Local inspection indicates a tight swelling at the vulva that darkens and turns purple.
Under GA, investigate the haematoma while taking aseptic precautions.
Give the antibiotics on schedule and explain to the mother.

Questions and Answers

What are the Causes of vulval haematoma ?

Causes of vulval haematoma are ;

Inadequate homoeostasis during the healing of an episiotomy wound or vaginal or perineal tear.
Failing to take safety measures when stitching the tear's peak.
Not completely closing the dead space while sewing the vaginal walls.
Paravaginal venous plexus rupture, either naturally or as a result of assisted birth.

How can we manage vulval haematoma ?

In the third or fourth stage of labor, effective management should be carried out.
Early haematoma detection is important.
Investigate the haematoma in the operating room while using aseptic technique.
Provide perineal care every four hours and, when needed, replace the wet pad.
Inform the mother on personal hygiene and walking.
As soon as the antibiotics are ready, give them to the mother and go over when and how to take them.