Postpartum hematomas are localized blood collections that can form in the connective tissue beneath the skin or vaginal mucosa after childbirth, usually without laceration. They are caused by trauma during delivery or inadequate suturing. Symptoms include pain, discolored skin, and decreased blood pressure or lochia flow. Small hematomas are monitored but large ones may require evacuation. Complications can include infection, anemia, and prolonged recovery. Nurses monitor for signs, provide pain relief, and educate on diet, hygiene and recovery.

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.