Name: Vulvovaginal Hematoma Management Protocol
Creator: Dr. Lucas Mastropaolo

Approach to the Critical Patient

Resuscitation Triggers

Hemodynamic instability criteria

Immediate Stabilization

Initial stabilization priorities

Consultant Activation

Early specialist triggers

Pitfalls

Critical pitfalls in vulvovaginal hematoma

History

Mechanism of Injury

Obstetric mechanisms

Non-obstetric mechanisms

Symptom Characterization

Pain and swelling profile

Associated symptoms

Risk Factors

Obstetric risk factors

Medical risk factors

Anatomic risk factors

Past Medical and Obstetric History

Relevant history elements

Physical Exam

Vital Signs and Hemodynamic Assessment

Hemodynamic parameters

External Genital Examination

Vulvar and labial inspection

Vaginal and Rectal Assessment

Internal examination findings

Urologic Assessment

Urinary tract evaluation

Differential Diagnosis

Life-Threatening Mimics

Emergent differential diagnoses

Infectious and Structural Mimics

Non-hemorrhagic vulvar masses

Vascular and Neoplastic Causes

Vascular and oncologic differential

Laboratory Tests

Hematologic Studies

Complete blood count

Type and Crossmatch

Blood bank studies

Coagulation Studies

Coagulation panel

Metabolic and Pregnancy Studies

Additional laboratory workup

Diagnostic Tests

Scoring Systems

Severity stratification tools

MRI

MRI indications and findings

CT

CT with intravenous contrast indications

Ultrasound

Ultrasound applications

Disposition

Admission Criteria

Inpatient admission indications

Observation Criteria

Short-stay observation indications

Discharge Criteria

Safe discharge requirements

Treatment

Conservative Management

Non-operative treatment (stable, non-expanding hematomas without extravasation)

Analgesia

Pain management protocol

Surgical Intervention

Operative management (rapidly expanding, hemodynamically significant, or > 5 cm per ACS guidelines)

Transcatheter Arterial Embolization

TAE protocol (preferred before surgical exploration for postpartum hematomas with extravasation)

Blood Product Resuscitation

Transfusion management

Special Populations

Pregnancy

Antepartum and intrapartum considerations

Geriatric

Older adult considerations

Pediatrics

Premenarchal and adolescent considerations

Background

Epidemiology

Incidence and prevalence data

Pathophysiology

Mechanisms of hematoma formation

Therapeutic Considerations

Evidence base for management decisions

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for vulvovaginal hematoma

Return to the emergency department immediately if any of the following occur

References

Guidelines and Key Sources

Primary clinical guidelines

Key Studies

Landmark and supporting evidence

Learn More: Vulvovaginal Hematoma

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by Dr. Lucas Mastropaolo, MD, CCFP(EM) · Last reviewed June 19, 2026

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