Winkelman Jeremy, Murphy Kevin, Booth Cynthia
University of Arizona College of Medicine Phoenix, Ringgold ID 42283, United States.
Case Rep Womens Health. 2023 Jun 7;38:e00518. doi: 10.1016/j.crwh.2023.e00518. eCollection 2023 Jun.
Vulvar hematomas are more common in the obstetric population, and usually present within 24 h of delivery. Small, nonexpanding vulvar hematomas will often resolve with conservative management. In a rural setting in the USA, a 35-year-old woman, G3P3, presented to clinic 26 days after a home vaginal delivery attended by a midwife, which was complicated by postpartum hemorrhage secondary to retained placenta. Ten days after her delivery she developed intense pressure in her inferior right vulva. On examination a 4-5 cm well defined right vulvar mass was observed. Incision and drainage were performed and the mass was determined to be a hematoma that had not resorbed. Four days later, the patient returned to clinic as the mass had reformed. Computerized tomography did not show extravasation of contrast. As examination showed the mass was now 1 cm smaller, no intervention was undertaken and after one month the hematoma had completely resolved. This case provides a rare example of the delayed development of a vulvar hematoma. In the literature, the vast majority are reported to present within 24 h of delivery. Smaller hematomas, such as this one, which was 4-5 cm, are treated conservatively, as they typically absorb. This hematoma was present for approximately two weeks without resorbing.
外阴血肿在产科人群中更为常见，通常在分娩后24小时内出现。较小的、无扩大的外阴血肿通常通过保守治疗即可消退。在美国的一个农村地区，一名35岁、孕3产3的妇女，在由一名助产士接生的家庭阴道分娩后26天到诊所就诊，此次分娩因胎盘残留继发产后出血而复杂化。分娩后10天，她感到右下外阴有强烈的压迫感。检查时发现右侧外阴有一个4 - 5厘米边界清晰的肿块。进行了切开引流，确定肿块为未吸收的血肿。四天后，患者因肿块复发回到诊所。计算机断层扫描未显示造影剂外渗。由于检查显示肿块现在小了1厘米，未采取任何干预措施，血肿在之后完全消退。该病例提供了一个外阴血肿延迟发生的罕见例子。在文献中，绝大多数报道称血肿在分娩后24小时内出现。像这个4 - 5厘米的较小血肿通常会自行吸收，因此采取保守治疗。这个血肿存在了大约两周仍未吸收。
