Endovascular Management of Episiotomy Site Hematoma: Two Cases and a Brief Review

Background-Episiotomy site hematoma though uncommon, can be associated with serious maternal morbidity. It arises mostly due to tissue trauma or may occur due to injury to blood vessel, leading to formation of pseudoaneurysm. Sometimes, when surgical management fails embolization of the bleeding vessel is a lifesaving option. Here, we are reporting two cases of episiotomy site hematoma which required selective arterial embolization for management, following failure of surgical management.
Case 1-A-28- year old,G6A5 underwent forceps delivery following which she developed 6*6 cm right sided vulvovaginal hematoma at the episiotomy site. After a failed surgical management, arterial embolization was performed and hemostasis achieved.
Case 2- A-26-year old P2L2 with history of surgical exploration for episiotomy site hematoma, postdelivery on postpartum day seven presented with profuse vaginal bleeding. Her CT angiogram revealed pseudoaneurysm of around 2.1*1cm along with vaginal hematoma of 4*5cm.Selective artery embolization done and complete hemostasis achieved with no complication.
Conclusion-Selective arterial embolization is a safe therapeutic option for episiotomy site hematoma especially if surgical management fails.
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