Postpartum angiographic embolization for vulvovaginal hematoma - A report of two cases

BACKGROUND: Puerperal hematomas can become a life-threatening obstetric eme rgency. Their incidence is 1 or 2/1,000 deliveries. When mainstay methods o f suture and packing fail, arterial embolization becomes an excellent alter native to definitive treatment, laparotomy. CASES: A 32-year-old woman, para 2-0-2-2, developed extreme rectal and vulv ar pain one hour postpartum. A 12X10-cm vulvovaginal hematoma was identifie d, drained, sutured and packed. Bleeding continued, blood products were adm inistered, and selective angiographic embolization of the pudendal and infe rior gluteal arteries was successfully performed. A 32-year-old woman, para 1-0-1-1, developed a left vaginal hematoma immediately postpartum. She fai led vaginal packing and underwent angiographic arterial embolization succes sfully. The patient was discharged on the fourth postpartum day. At six wee ks postpartum, neither patient had evidence of hematoma formation. CONCLUSION: In the setting of a puerperal hematoma refractory to convention al first-line therapy, arterial embolization provides a rational, effective alternative for achieving hemostasis with minimal morbidity.