Vulvar Hematoma Research Articles

Differential diagnosis in vulvar hematoma: sexual assault is not the only explanation. The importance of medico-legal evaluation in an unusual case report

Differential diagnosis in vulvar hematoma: sexual assault is not the only explanation. The importance of medico-legal evaluation in an unusual case report

101. Traumatic Vulvar Hematomas in Pre- and Post-menarchal Patients

101. Traumatic Vulvar Hematomas in Pre- and Post-menarchal Patients

Spontaneous Vulvar Hematoma after Colonoscopy in a Patient with Von Willebrand Disease

Abstract Vulvar hematomas in non-obstetric patients are rare and typically develop after trauma to the area. Management options include conservative and surgical options and are dependent on size of the hematoma and patient symptoms. We present the case of a patient with von Willebrand disease who presented with a large vulvar hematoma two days after undergoing colonoscopy.

Extensive Vulvar Hematoma as a Complication of Labiaplasty: A Case Report

Vulvar hematoma is an extremely rare complication outside obstetric practice. Owing to the vulvar structure and its rich blood supply, hematoma can reach an enormous size over a short period. Although direct trauma is the anesthetic 31-year-old nullipara admitted for acute massive vulvar swelling as a complication of labiaplasty. She scored 10 on the pain scale. Upon admission to the emergency department, she had normal vital signs and was immediately started on intravenous acetaminophen and prophylactic antibiotics. The patient was subsequently transferred to the operating theater for examination and drainage of the hematoma under anesthesia. Reconstruction of the labia was performed. The patient had a smooth postoperative course and was discharged on the 3rd postoperative day. We concluded that Anesthetic gynecological procedures, although categorized as minor, can result in grave sequelae, and must therefore be performed in a hospital set-up.

Teenage Pregnancy Outcome in Rapti Sub Regional Hospital

Aim: To determine the maternal and perinatal outcome in teenage pregnancies. 
 Methods: A hospital based descriptive cross sectional study conducted from April 2017 to April 2018, among the pregnant women of age group≤19 years, admitted to the labour ward atRapti Sub regional Hospital, Dang.
 Results: The total of 853 pregnant adolescent women were admitted during the study period, most of which belonged to 19 years of age (38.6%) and were primipara (93.3%) and 42.1% belonged to janjati group. 79.6% had normal delivery, while 14.1% of the cases underwent caesarean section, 5.9% had instrumental delivery and in 0.5% had perineal injury. Anaemia complicated 63% of teenage mothers, more in age group of ≤ 18yrs than in > 18years (61.4%vs 38.6%) and 4.6% had maternal complications, the majority being PPH (2.9%) followed by oligohydraminos, eclampsia, wound infection and vulvar haematoma. Preterm delivery occurred in 15.5% of the cases (≤ 18yrs vs>18yrs being 9.8% vs 5.7%), other neonatal complications included respiratory distress (1.5%), intrauterine growth retardation (4.5%), intrauterine foetal death (0.4%) and very low birth weight (1.2%).
 Conclusions: Teenage pregnancy has increased risk of adverse pregnancy outcomes leading to various adverse maternal, fetal and neonatal complications.
 Keywords: outcome, pregnancy, teenage.

Symptomatic vulvar mucinous cyst: A case report and review of the literature

BackgroundVulvar mucinous cysts are rare, benign, noninvasive masses. They can be mistaken for cysts of Bartholin gland, Skene gland, vestibular, or canal of Nuck. Generally, they may be left untreated, but observed. However, if symptomatic, they may require surgical removal.CaseWe report a large vulvar mucinous cyst in a 29-year-old woman with no contributory medical history. Excision of the mass was performed because its size had begun to cause symptoms. The diagnosis of a mucinous cyst was based on radiological and clinicopathologic features. The patient developed a post-operative vulvar hematoma and was discharged 2 days after the surgery with a Foley catheter in place. Continued follow-up was maintained for the hematoma, which drained spontaneously and resolved without incident. There has been no recurrence of the cyst after completion of short-term surgical follow-up.ConclusionVulvar mucinous cysts are rare masses. We present the diagnosis and treatment of a large vulvar mucinous cyst. The cyst was completely removed during surgery, but long-term surveillance for recurrence is currently being conducted.

Spontaneous vulvar hematoma as a rare manifestation of congenital hypofibrinogenemia. Case report

Introduction: Congenital fibrinogen disorders are rare conditions in which there are quantitative and qualitative alterations of factor I; the vast majority of patients are asymptomatic.Case presentation: A 19-year-old female patient with a history of congenital hypofibrinogenemia presented with spontaneous vulvar hematoma along with hypotension, tachycardia, stupor and hematoma of 20cm in the right labium majus. On admission, the young woman had hemoglobin 6.6 g/dL, fibrinogen 74 mg/dL and prolonged clotting times. She received red blood cells transfusion and cryoprecipitates, followed by surgical drainage and intravenous fibrinogen replacement, adjusting the dose according to fibrinogen levels in plasma. The patient presented progressive improvement without hemorrhagic recurrence and fibrinogen levels within the target values until hospital discharge.Discussion: Afibrinogenemia and hypofibrin­ogenemia are part of the quantitative factor I disorders; in the first case, there is total absence of circulating fibrinogen, and in the second case the levels are below 150 mg/dL. Sponta­neous vulvar hematoma as a severe hemorrhagic manifestation is not frequent in symptomatic patients; its treatment is based on fibrinogen replacement in an individualized manner and surgical management when required.Conclusion: Hypofibrinogenemia is a rare dis­ease, and fibrinogen replacement is one of the mainstays of treatment.

Primary pseudomyogenic hemangioendothelioma of the vulva: a rare location for a rare entity

BackgroundPseudomyogenic hemangioendothelioma (PMHE) is a recently described vascular neoplasm which typically occurs in the lower extremities of young to middle-aged adults.Case presentationWe present here a unique case of PMHE arising primarily in the vulva of a 51-year-old woman who presented with a painful vulvar nodule. Clinically, it was thought as Bartholin gland cyst, vulvar hematoma or papilloma. On surgery, two nodules were found with one located in the superficial dermis and the other in the deep subcutis. Histologically, these two nodules showed similar features, composed of fascicles or sheets of plump spindled to epithelioid cells with eosinophilic cytoplasm. Given the morphological resemblance to a myogenic tumor, the lesion was initially diagnosed as a rhabdomyosarcoma by the referring pathologist. However, a comprehensive reevaluation of the submitted slides made us reconsider a PMHE, which was subsequently confirmed by immunohistochemical study.ConclusionThis case demonstrates that PMHE can also develop in the female external genitalia albeit extremely rare. This disease should be included in the differential diagnostic list of vulvar tumors with spindled to epithelioid morphology and cytokeratin-positive immunophenotypes.

Clinical characteristics, treatment indications and treatment algorithm for post-partum hematomas.

Post-partum hematomas are a serious obstetrical complication. Choosing treatments for post-partum hematomas is difficult, and the application of transcatheter arterial embolization remains unclear. We aimed to clarify the clinical characteristics, identify the treatment indications and create a treatment algorithm for post-partum hematomas. Fifty-four patients with post-partum hematomas were enrolled. Hematomas were categorized according to location: upper vaginal, lower vaginal and vulvar. Blood loss, treatment methods and other clinical data were collected from the patients' medical records and analyzed retrospectively. Five, 19 and 30 patients had upper vaginal wall, lower vaginal wall and vulvar hematomas, respectively. All upper vaginal wall hematomas required transcatheter arterial embolization to control bleeding, and the average blood loss was 2473 ± 1689 mL. Most lower vaginal wall hematomas were treated surgically; however, two patients required transcatheter arterial embolization, and the average blood loss in these patients was much higher (2010 ± 1145 mL) than that in patients with lower vaginal wall hematomas (395 ± 316 mL). No patient with vulvar hematomas was treated with transcatheter arterial embolization. Two and four patients with vulvar and lower vaginal wall hematomas, respectively, were managed with observation. We created an algorithm for post-partum hematoma management. Post-partum hematoma location should guide treatment selection. Transcatheter arterial embolization should be selected for upper vaginal wall hematomas. Most lower vaginal wall hematomas are treatable with surgery, but transcatheter arterial embolization should be considered for hemostasis in difficult cases. Management with observation may also be possible for lower vaginal wall and vulvar hematomas.

Vulvar hematoma in puerpera with Von Willebrand's disease of a maternity in Amazon region

Vulvar hematoma in puerpera with Von Willebrand's disease of a maternity in Amazon region

Maternal Morbidity in Vaginal Delivery with or without Episiotomy in Nulliparous Women

Introduction: Episiotomy incision is the most common surgical procedure around the globe and in many countries, it became a routine policy. Episiotomy in all women with vaginal delivery has no benefit. Rate of episiotomy varies widely around the globe, while in Nepal all nulliparous and primi-parous hospital deliveries are given routine episiotomy. So, this study aimed to compare the maternal morbidity during first vaginal birth in women with or without episiotomy.Methods: This is a hospital based randomized prospective comparative study conducted in the Obstetrics and Gynaecology department of a teaching hospital. The subjects were divided into episiotomy group and no episiotomy group. Under local anaesthesia mediolateral episiotomy was given in the second stage with crowning of the head in episiotomy group. Nature of morbidity seen were recorded in both the groups immediately after delivery, after 6 hours and after 1 week and compared.Results: In no episiotomy group intact perineum 26.3%, laceration 10.5%, spontaneous perineal tear (first and second degree) 63.1% was observed. Total perineal surgical repair was 81.55%. Intact perineum was high among no episiotomy group. Third degree tear, vulval haematoma, wound gaping, perineal oedema were seen in episiotomy group.Conclusion: Anterior perineal laceration rate was high in no episiotomy group than episiotomy group but overall few morbidities were in no episiotomy group than in episiotomy group. So, episiotomy should not be considered to prevent insignificant anterior perineal lacerations.

Managing vulvovaginal hematoma by arterial embolization as first-line hemostatic therapy

ObjectiveA puerperal vulvovaginal hematoma may continue to grow after a surgical procedure and may require blood transfusion. Thus, we selected arterial embolization for hemostasis as the first-line management in two cases of large vulvovaginal hematoma. Materials and methodsCase 1 was a 32-year-old pregnant woman. After delivery, a 10-cm vulvar hematoma developed. An enhanced computed tomography (CT) scan revealed active bleeding. Arterial embolization was performed and complete hemostasis was obtained. Case 2 was a 34-year-old woman with a recurring hematoma after delivery. An enhanced CT scan revealed extravasation in the hematoma. Gelatin sponges were applied and complete hemostasis was obtained. In both cases, arterial embolization was successful without requiring blood transfusions. Results and conclusionWe successfully managed two cases of puerperal vulvovaginal hematoma by arterial embolization based on the evaluation of an enhanced CT scan. In conclusion, we suggest arterial embolization to be a viable option for first-line treatment in the management of vulvovaginal hematomas.

Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Appropriate surgical intervention can avert morbidity and mortality.

A new technique for management of postpartum vulvar hematoma; case report

A new technique for management of postpartum vulvar hematoma; case report

Spontaneous Bilateral Vulvar Hematoma During Pregnancy

Abstract Background: Vulvar hematomas are uncommon. They may be the result of traumatic injury in nonpregnant women or present as an uncommon complication of childbirth. This article describes an unusual case of a spontaneous bilateral hematoma that presented with unexplained vulvar swelling in a 25-weeks' pregnant woman. Case: A multiparious, 32-year-old, pregnant woman presented with bilateral vulvar swelling and rapid onset of pain. Fifteen weeks prior, she had found a 3–4-cm cystic mass on the bilateral labia although she had no preceding traumatic event. Detailed physical and imaging evaluation suggested spontaneous vulvar hematomas. She was treated successfully with surgical evacuation of hematoma clots. Results: After this treatment, the patient went on to have an uneventful vaginal delivery at the 38th week of her pregnancy. Conclusions: An accurate recognition of spontaneous vulvar hematoma during pregnancy can enable complete recovery for a patient so she can continue a normal pregnancy with an ...

A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery

Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.

Bull Gore Injury of the Vagina

Although an obstetrically related trauma is the most common cause of the injuries to the female genital tract, non obstetric causes also lead to a significant number of vaginal and vulval injuries. We present 2 cases of vaginal injury, due to bull goring, one of which was associated with massive vulval haematoma. The 2 cases presented in a span of 2 months, in a rural medical college in South India. Both of them were managed surgically, following an initial haemodynamic resuscitation. They also required blood transfusions and an antibiotic prophylaxis. The postoperative period was uneventful.

Labour analgesia and anaesthetic management of a primigravida with uncorrected Pentology of Fallot

Tetraology of Fallot is the most common congenital heart disease causing intracardiac right-left shunts. It is characterized by presence of ventricular septal defect, aortic overriding, pulmonary artery outflow obstruction and right ventricular hypertrophy. When these features are associated with atrial septal defect, it is often referred to as Pentology of Fallot (POF). If the lesions remain uncorrected, they can cause significant morbidity and mortality to the patient. Pregnancy and labour in such a patient present with significant haemodynamic changes, which can be challenging to the anaesthesiologist. Our patient with POF was managed with labour analgesia and subsequently epidural anaesthesia for drainage of vulval haematoma with successful outcome.

Rapid hypnosis as an anaesthesia adjunct for evacuation of postpartum vulval haematoma

Hypnosis can be a useful therapeutic adjunct to pharmacological analgesia or anaesthesia in obstetrics. However, it is rarely considered a primary anaesthetic technique and is seldom employed in the acute surgical setting. Few obstetricians and anaesthetists currently utilise this technique in their clinical practice. We present a case report of a 34-year-old woman who successfully underwent evacuation of a large vulval haematoma using the simple hypnosis technique of 'believed-in imagination' as the principal anaesthetic technique with only minimal adjunctive pharmacological analgesia.

Initial Experience in a Vulvovaginal Aesthetic Surgery Unit Within a General Gynecology Department

To evaluate what the appropriate indications are for vulvovaginal (VV) plastic surgeries in our environment. This is a retrospective study of 73 consecutive patients who were seen on consultation at the gynecologic aesthetic unit between January 2008 and January 2009 asking for a VV aesthetic surgery.All patients completed the Female Sexual Function Index questionnaire and received information on sexuality. Of the 73 patients seen on consultation, 32 (43.8%) underwent surgery, and the main reason for this was reduction labioplasty in 19 patients, widening vaginoplasty in 6, reduction vaginoplasty in 1, and resection of asymmetries in 6 patients. None of the patients seen on consultation for vulvar bleaching, G-spot amplification, or augmentation labioplasty underwent surgery. Postoperative complications included wound dehiscence in 3 patients (9.3%) and a vulvar hematoma in 1 patient (3.1%).Postoperative sexual satisfaction was optimal for 30 patients; only 2 complained of dyspareunia. Most patients seen on consultation for VV plastic surgery had no need for it and only received information regarding female anatomy and sexuality. Reduction labioplasty owing to hypertrophy of the labia minora represented the most frequent reason for consultation and surgery. Indications for VV plastic surgeries should be based not only on surgical results but also on the reported satisfaction achieved by those patients who did not undergo surgery and only received appropriate information during consultation.