CHHS17/287

Canberra Hospital and Health Services

Clinical Procedure
Haematoma Management following Vaginal Birth
Contents

Contents ..................................................................................................................................... 1
Purpose....................................................................................................................................... 2
Alerts .......................................................................................................................................... 2
Scope .......................................................................................................................................... 2
Section 1 – Risk Factors .............................................................................................................. 2
Section 2 – Management ........................................................................................................... 3
Implementation .......................................................................................................................... 4
Related Policies, Procedures, Guidelines and Legislation .......................................................... 4
References .................................................................................................................................. 4
Search Terms .............................................................................................................................. 5

Doc Number Version Issued Review Date Area Responsible Page

CHHS17/287 1 27/11/2017 01/12/2021 WY&C - Maternity 1 of 5
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
 CHHS17/287

Purpose

Midwives and medical officers will initiate and provide appropriate care and interventions
for women who develop a haematoma following a vaginal birth.

To quickly identify and manage vulval and vaginal haematomas appropriately.

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Alerts

Vulval/vaginal Haematomas can develop rapidly and lead to significant pain and maternal
haemodynamic compromise. Prompt recognition and management is required to prevent
adverse outcomes.

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Scope

This document applies to the following Canberra Hospital and Health Services (CHHS) staff
working within their scope of practice:
 Medical Officers
 Registered Midwives and Nurses
 Student Midwives and Nurses under direct supervision.

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Section 1 – Risk Factors

Risk factors:
 episiotomy
 instrumental birth
 primiparity
 prolonged second stage of labour
 macrosomia
 multiple pregnancy
 vulval varicosities
 preeclampsia
 perineal repair where haemostasis has not been adequately achieved.

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Doc Number Version Issued Review Date Area Responsible Page

CHHS17/287 1 27/11/2017 01/12/2021 WY&C - Maternity 2 of 5
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
 CHHS17/287

Section 2 – Management

The three primary approaches for managing puerperal haematomas are

1. Conservative management with observation and supportive care
2. surgical intervention
3. selective arterial embolisation.

After birth observe the woman for the following signs and symptoms of vulval or vaginal
hematoma
 feeling of pain/fullness in vagina or rectum
 pain that is disproportionate to that expected with an episiotomy or tear
 hardness and swelling of vulval area
 excessive bruising
 signs of maternal compromise disproportionate to observed/ measured blood loss
 unusually small or no visible signs of blood loss.

Procedure
 advise the Obstetric Registrar/Consultant promptly if a haematoma is suspected or
discovered
 monitor the woman’s haemodynamic state rigorously
 perform gentle vaginal examination if required with consent if vaginal wall haematoma is
suspected. Ensure the woman is positioned as comfortably as possible and ensure
adequate pain relief and good visualisation
 if the hematoma is at the site of a laceration that has been repaired, the repair may need
to be taken down by the Obstetric Registrar/Consultant staff to evacuate the hematoma.
The hematoma cavity is inspected to determine the extent of the injury and identify
bleeding vessels, which are individually ligated
 ensure adequate pain relief; psychological support, Ice packs, Nitrous oxide and oxygen,
+/- IMI analgesia may be necessary
 frequent observations of vital signs as haemodynamic compromise can be significant.
Refer to MEWs pathway
 catheterise if the woman is unable to pass adequate volumes of urine. Ensure adequate
analgesia for the procedure
 bleeding may track posteriorly, vaginally, or into the retroperitoneum and may not be
immediately recognised. Monitor pain level, swelling and haemodynamic status
frequently
 document in the clinical records a description of the size and position of haematoma and
treatment
 puerperal hematomas should be suspected in all postpartum women who demonstrate
signs of acute blood loss or hypovolemia, such as unexplained tachycardia, loss of
consciousness/ syncope or decreased urine output
 there is no evidence regarding the benefit of antibiotic therapy for women experiencing
a haematoma

Doc Number Version Issued Review Date Area Responsible Page

CHHS17/287 1 27/11/2017 01/12/2021 WY&C - Maternity 3 of 5
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
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 should evacuation under general anaesthetic be required, keep woman fasted and
facilitate transfer to theatre.

Outcomes
 The woman remains haemodynamically stable
 The haematoma is identified and managed effectively to minimise blood loss, other
morbidity and pain
 discomfort is relieved effectively with appropriate analgesia and positioning
 the woman is aware of what has occurred and the necessary interventions.

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Implementation

This guideline will be discussed at Multidisciplinary Education and Unit meetings. It will be
available to access via Policy and Clinical Guidance on the ACT Health Intranet.

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Related Policies, Procedures, Guidelines and Legislation

Policies
 Consent and treatment

Procedures
 Clinical Procedure, Perineal Care- Maternity

Guidelines
 Clinical Guideline, Obstetric Emergencies

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References

1. South Australian Perinatal Practice Guidelines Puerperal genital haematomas (2012)

http://www.sahealth.sa.gov.au/wps/wcm/connect/149020804eedac35b186b36a7ac0d6
e4/Puerperal-genital-haematomas-WCHN-PPG-
22052013.pdf?MOD=AJPERES&CACHEID=149020804eedac35b186b36a7ac0d6e4
2. Qld Government Clinical Guideline (2012) Perineal Care
https://www.health.qld.gov.au/__data/assets/pdf_file/0022/142384/g_pericare.pdf

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Doc Number Version Issued Review Date Area Responsible Page

CHHS17/287 1 27/11/2017 01/12/2021 WY&C - Maternity 4 of 5
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
 CHHS17/287

Search Terms

Vulval, Haematoma, Perineum, Vaginal

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services
specifically for its own use. Use of this document and any reliance on the information contained therein by any
third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:

Date Amended Section Amended Divisional Approval Final Approval
15/11/2017 Complete Revision Penny Maher, A/g DON CHHS Policy Committee
WY&C

This document supersedes the following:

Document Number Document Name
3.2.14 Maternity - Haematoma Management Following a Vaginal Birth

Doc Number Version Issued Review Date Area Responsible Page

CHHS17/287 1 27/11/2017 01/12/2021 WY&C - Maternity 5 of 5
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register