An Unusual Presentation and Surgical Repair of a Postpartum Pelvic Hematoma

Abstract

Background: Postpartum hematomas for the most part can be treated conservatively but if there is an open wound or it is expanding rapidly or causing hemodynamic instability then surgical intervention is required. The available resources and the practitioner's surgical experience then becomes key in order to minimize morbidity in the management of complex hematomas. A 29 year old primipara, after a vacuum assisted vaginal delivery developed an expanding labial hematoma, surprisingly extending from the mons pubis to the perirectal space and inwards to the ischio rectal fossa. The patient initially had incision and drainage followed by packing of the 10cm hematoma. The pt was then transferred to Cooper. A second complex surgical intervention with complete evacuation of the hematoma and layered closure was required. Traditional surgical intervention involving complete evacuation and layered closure is still essential in the management of open postpartum pelvic hematomas.