Treatment Strategies for Obstetric Puerperal Genital Hematomas

Puerperal genital hematoma is an infrequent but potentially life-threatening complication of childbirth. There are three approaches to care: expectant management, surgical evacuation, or uterine artery embolization.This retrospective case series compares the clinical courses of three patients who developed puerperal genital hematoma and were managed differently. We report the length of time to complete resolution of the hematomas and the associated morbidities for each patient.All three management approaches of puerperal genital hematoma can be effective. Among our three patients, surgical intervention of the puerperal genital hematoma provided the most prompt and definitive management with resolution of all symptoms in 9 days, compared with 3 weeks for expectant management and 20 weeks for treatment with uterine artery embolization. Intervention should be individualized based on the patient's symptoms, stability, and desires with consideration of the hematoma size and location as well as available institutional resources.