Which factor increases the risk for vulvar hematoma after delivery?

• A. Epidural anesthesia
• B. Spontaneous vaginal delivery without instruments
• C. Short second stage
• D. Absence of episiotomy

Answer: (A)

Vulvar hematoma after delivery happens when blood vessels in the perineal/vulvar area are injured and bleed into the tissues. Anything that increases tissue trauma or the chance of an instrument-assisted delivery can raise the likelihood of this bleeding.

Epidural anesthesia can contribute to this risk because it reduces sensation and motor function in the lower body, which can mask emerging perineal trauma and delay recognition of bleeding. It’s also associated with longer labor and a higher chance of instrument-assisted delivery (such as forceps or vacuum), both of which increase the potential for vascular injury in the vulvar region. When perineal tissues are stressed or torn, vessels can rupture more easily, leading to a hematoma.

In contrast, spontaneous vaginal delivery without instruments, a shorter second stage, and the absence of episiotomy generally reduce perineal trauma and bleeding risk, making vulvar hematoma less likely.