The use of ultrasound in the evaluation of postpartum paravaginal hematomas

Abstract

Background: Paravaginal hematoma can be a severe postpartum complication. Diagnosis is challenging because signs and symptoms are often nonspecific. Most of the available literature about diagnostic imaging in these cases focuses on the use of computed tomography or magnetic resonance imaging, and there are very limited data on the use of sonography.

Objective: The purpose of this study was to evaluate the usefulness of sonography in the diagnosis of paravaginal hematomas from a review of our own experience.

Study design: This was a retrospective study that included patients with postpartum paravaginal hematoma after vaginal delivery who underwent transabdominal or transperineal ultrasound in our University Hospital in Bologna from 2014-2016. Ultrasound features, dimensions, and relationship with other pelvic organs of the paravaginal hematoma were obtained. Information on patients' characteristics, symptoms, mode of delivery, treatment, and outcomes were recorded.

Results: We retrieved 11 cases of paravaginal hematoma after vaginal delivery in which ultrasound scanning was performed. The indications for ultrasound evaluation after delivery were pelvic and/or perianal pain, swelling of the vulva, and urinary retention, frequently in combination. The hematomas were always clearly visualized by sonography performed either transabdominally or transperineally with a full bladder as hypoechoic collections posterior to the vagina. The lesions were found to range in size of 4-10 cm. All patients underwent surgical treatment that consisted of incision of the hematoma and identification and ligature of any feeding vessels; packing was necessary in 8 cases (73%), and drainage was necessary in 5 cases (45%); however, 4 patients (36%) required reintervention.

Conclusion: Transabdominal (performed with a full bladder) or transperineal sonography can visualize paravaginal hematomas effectively after vaginal delivery. We suggest that in cases of otherwise unexplained postpartum pelvic and perianal pain, swelling of the vulva, and/or urinary retention, ultrasound can be considered as the first-line imaging tool.

Keywords: delivery; paravaginal hematoma; perineal; transperineal; ultrasound.