1. Postpartum
Hematomas
Hannilore Villamor, RN

2. Postpartum hematomas
• Localized collections of blood in loose
connective tissue beneath the skin
covering external genitalia, beneath
the vaginal mucosa, or in the broad
ligaments
• Usually occurs without laceration of
the overlying tissue

3. PATHOPHYSIOLOGY AND
ETIOLOGY

4. • Trauma during spontaneous labor
• Trauma during operative vaginal
delivery
• Inadequate suturing of an episiotomy
• Delayed homeostasis or difficult or
prolonged second stage of labor, or
both

5. CLINICAL
MANIFESTATIONS

6. • Complaints of pressure and pain
 Pain may be verbalized as
excruciating.
• Discolored skin that is tight, full
feeling, and painful to touch.
• Possible decrease in BP, tachycardia.
• Decrease or absence of lochia flow if
the vagina is impeded

7. MANAGEMENT

8. • Small hematomas (< 3 cm) are left to
resolve on their own—ice packs may
be applied
• Large hematomas (> 3 cm) may
require evacuation of the blood and
ligation of the bleeding vessel
• Analgesics and broad-spectrum
antibiotics may be ordered
 Due to increased chance of
infection

9. COMPLICATIONS

10. • Hypovolemia and shock from extreme
blood loss
• Anemia, infection
• Increased length of postpartum
recovery period
• Sepsis
• Calcification and scar tissue
• Dyspareunia (painful intercourse)

11. NURSING
INTERVENTIONS AND
PATIENT EDUCATION

12. • Inspect perineal and vulvar area for
signs of a hematoma periodically
postpartum
• Inspect the vaginal area for signs of a
hematoma if woman is unable to void
• Monitor vital signs periodically and
evaluate for signs of shock

13. • Relieve pain of a hematoma:
 Apply an ice bag to perineal area
 Medicate with mild analgesics
 Position for comfort to decrease
pressure on the affected area
• Catheterize patient if unable to void
• Teach the woman the importance of
eating a balanced diet and to include
food high in iron

14. • Help relieve voiding problems by
assisting to bathroom to void if able
to ambulate
• If patient is unable to ambulate, then
assist her to sit on bedpan with legs
hanging over side of bed
• Provide privacy, and run water while
the woman is attempting to void

15. • Encourage the woman to take vitamin
supplements and to take medications
as ordered.
• Instruct the woman in the use of the
sitz bath to provide perineal comfort
after the first 24 hours and at home.