This leaflet is to help you understand Paravaginal hematoma.

What is a paravaginal hematoma?

A paravaginal hematoma, or vaginal hematoma, is a sort of deep bruise. It is a blood collection that pools in the soft tissue around the vagina. It is the consequence of an injury to the blood vessels, which leads to leak into the surrounding tissues.


How does a paravaginal hematoma happen?

As with all hematomas, a paravaginal hematoma results from an injury to a blood vessel. Post-partum paravaginal hematomas are rare complications of vaginal delivery. Although most paravaginal hematomas occur when a vacuum or a forceps is used to deliver the baby, they can happen also during a normal vaginal delivery. As the vagina contains many blood vessels compared to other parts of the body, a laceration involving these vessels can sometimes result in a hematoma.


Should I have more tests done?             

To diagnose a paravaginal hematoma your doctor will perform a visual and digital exam of your perineum, including a vaginal examination. If necessary, your doctor might also order one or more of the following tests:

  • Ultrasound: Ultrasound is usually well tolerated by the patients. To assess the paravaginal hematoma your doctor might use a transabdominal or a transperineal probe. Transabdominal ultrasound is the same technique you experience during pregnancy, using a hand-held probe on your abdomen, in example during the second trimester anatomy scan in the second trimester. To better visualize the hematoma, you will need to have a full bladder, so the doctor may ask you to drink a lot of water or he may need to fill your bladder with a urinary catheter. The scan should not be uncomfortable, except for the pressure you will feel on the full bladder. To perform a transperineal ultrasound the doctor will use the same probe, covered by a lot of gel and a sterile glove. More gel will be then applied over the covered probe and it will be placed on the perineum, outside the vagina. This can feel a bit cold sometimes but the scan itself should not be uncomfortable, you will just feel the pressure of the probe.
  • CT scan (computer tomographic scan): a CT scan is used to create a visual of body tissues, like the perineum. It can allow the visualization of several details, which are useful for the diagnosis. The scan does not take long to complete and it is painless. In some circumstances, a contrast dye may be injected in your veins to make the CT scan images clearer.
  • MRI (magnetic resonance imaging): an MRI can be used to image the soft tissues as the paravaginal space, where a hematoma can happen. To have an MRI performed you will lie on a table that slides into the machine tube. You might hear a loud sound during the test.


What are the things to watch for?

  • Perineal pain and perineal pressure: paravaginal hematomas are often painful and they may present with a rectal pressure
  • Anemia: a large paravaginal hematoma may result in hemorrhage with subsequent anemia. If you are anemic, you may look very pale and feel very tired or experience light-headedness.
  • Fever: paravaginal hematomas may cause post-partum fever


Will it happen again?

The risk of recurrence in the next pregnancy is uncertain. Even when diagnosed and repaired, paravaginal hematomas may need a second surgical intervention in 36% of cases.


What other questions should I ask?

  • Does this look like a severe paravaginal hematoma?
  • How big is the hematoma?
  • What is the plan for my pain control?
  • Do I need surgery?
  • How often will I have ultrasound examinations done after the treatment?


Last updated February 2024