Vulvar hematoma is a localized collection of blood in the connective tissue beneath the skin covering the external genitalia or vaginal mucosa.

It generally forms as a result of injury to the perineal blood vessels during the delivery process.

a. Causes of Hematomas.

(1) Rapid, spontaneous delivery.

(2) Perineal varicosities.

(3) Episiotomy repairs.

(4) Laceration of perineal tissues.

b. Signs and Symptoms.

(1) Severe, sharp perineal pain.

(2) Appearance of a tense, sensitive mass of varying size covered by discolored skin.

(3) Swelling in the perineal wall.

(4) Often seen on the opposite side of the episiotomy.

(5) Inability to void due to pressure/edema on or around the urethra.

(6) Complaint of fullness or pressure in the vagina.

c. Medical Treatment.

This is consists of analgesics given for discomfort, opening the hematoma so blood clots can be evacuated and the bleeders can be ligated, and packing for pressure.

d. Nursing Interventions.

(1) Apply ice to area of hematoma.

(2) Observe for evidence of enlarged hematoma.

(3) Flag the patient’s chart if packing was inserted.