VULVO-VAGINAL HEMATOMAS COMPLICATING DELIVERY - RATIONALE FOR DRAINAGE OF THE HEMATOMA CAVITY

OBJECTIVE: To review the management of puerperal vulvovaginal hematoma s and report on the rise of closed system drainage in cases in which o perative intervention was used. STUDY DESIGN: A retrospective review o f medical records for a five-year period was conducted. The charts of all patients in whom puerperal vulvovaginal hematomas occurred were re viewed and data extracted regarding possible etiologic factors, detail s of delivery, characterization of the hematoma, surgical intervention and type of dl ain used. Also recorded was length of stay and postope rative complications. RESULTS: Eleven patients with hematomas were ide ntified, for an incidence of 1/526. All patients received antibiotics; transfusion was required in eight patients. Drains were used in nine patients: Penrose in four and closed system drainage in five. All drai ns were brought through a separate site distant from the repair. There was one postoperative abscess, which resolved with wound care, result ing in no long-term morbidity. CONCLUSION: Puerperal vulvovaginal hema tomas may be a life-threatening event. Review of the literature and ou r experience suggests that aggressive operative management and the use of drains are beneficial in the management of these patients. closed system drainage may be an effective adjunct in the management of vulvo vaginal hematomas.