Vaginal/Vulvar Hematoma

After birth, a patient can lose blood into the vulvar or vaginal tissues without obvious external bleeding. Trauma can rupture branches of the internal pudendal artery or accompanying veins; the collection expands in soft tissue, causing pressure, pain, and sometimes urethral obstruction. The experienced nurse notices a mismatch: pain is escalating or disproportionate to the visible tear, and swelling is tense, unilateral, bruised, or newly palpable. Start by determining stability and whether the mass is enlarging. A stable hematoma smaller than 5 cm can often be managed conservatively, while a collection at least 5 cm, rapid expansion, a significant hemoglobin fall, severe uncontrolled pain, or shock requires urgent provider-led intervention. The RPN initiates assessment, ordered supportive care, and escalation within provincial scope and local policy; evacuation, ligation, and embolization require the appropriate provider or specialist team.