Postpartum vulvovaginal hematoma is a complication of vaginal delivery that may progress to life-threatening conditions. However, the management of hematomas, including conservative therapy, surgery, and arterial embolization, is yet to be standardized.
This study aimed to i) evaluate hematoma features that can be treated conservatively, and ii) determine which is superior in reducing blood transfusion between surgery and transcatheter arterial embolization.
This cross-sectional study included postpartum women transferred to Tohoku University Hospital, Japan, between January 2016 and September 2023 for postpartum vulvovaginal hematomas. Notably, all patients except one underwent contrast-enhanced computed tomography. The patients were classified into i) the conservative group who received neither surgery nor transcatheter atrial embolization and ii) the therapeutic intervention group who received surgery or transcatheter atrial embolization. The primary analysis included all patients. Variables for the choice of therapeutic intervention, including the shock index, hemoglobin concentration at arrival, hematoma size, and presence of extravasation, were assessed using a modified Poisson regression model. The secondary analysis included patients who received therapeutic intervention (i.e. surgery or transcatheter atrial embolization). Variables for estimating the total amount of blood transfusion, including shock index, hemoglobin concentration at arrival, hematoma size, type of intervention, and presence of extravasation, were analyzed using multiple linear regression.
Fifty-seven cases were included in this study. Patients underwent conservative treatment (n= 19), surgery (n= 11), or transcatheter arterial embolization (n= 27). In primary analysis, only the presence of extravasation was significantly associated with the choice of therapeutic intervention (adjusted risk ratio [95% confidence interval], 5.30 [1.53, 18.37]). In the secondary analysis, the therapeutic option for surgery (unstandardized coefficients [95% confidence interval], 4.64 [1.15, 8.13], reference: transcatheter atrial embolization), lower hemoglobin concentration at arrival (-2.84 [-4.71, -0.97], 1 g/dL increment), and larger hematoma size (3.38 [1.23, 5.53], 100 cm3 increments) were significantly associated with increased blood transfusion.
When a vulvovaginal hematoma does not undergo extravasation, it can be treated conservatively regardless of size. When a therapeutic intervention is selected, transcatheter arterial embolization reduces the total amount of blood transfusion compared with surgery.