A rare cause of postpartum hemorrhage: the genital thrombus

Abstract

We report the case of a 30-year old primiparous patient, having given birth to a 3500g boy by cesarean section due to acute fetal distress. Two hours after childbirth, the patient had bilateral painful ecchymotic vulvar swelling suggesting post-partum thrombus of the vulva. Given the clinical stability of the size of this hematoma, the absence of unbearable pain and the stable hemodynamic status, conservative medical treatment (ice bag + NSAIDs). Output was favorable with progressive decrease in the size of the hematoma until disappearance 8 weeks after delivery. Thrombus or genital hematoma is a rare but potentially very serious post-partum haemorrhagic complication. There are four major types of genital hematomas: hematoma of the vulva, vulvo-vaginal hematoma, vaginal hematoma and pelvic-abdominal hematoma. The contributing factors are primiparity, instrumental extractions, toxaemia of pregnancy, twin pregnancies and vulvovaginal varicose veins. It is essential to suspect it in patients with pain and/or internal postpartum hemorrhage, and, if any doubt exists, to perform vulvovaginal inspection. Early treatment is necessary and should be associated with hemodynamic resuscitation, first-line surgery and percutaneous radiologic arterial embolization in case of failure of surgery.