A woman with a large vulvar hematoma can often be managed conservatively with external compression and application of ice packs. However, sometimes surgical management is indicated.
Elements of surgical management:
(1) evacuate the hematoma
(2) ligate bleeding vessels
(3) ensure hemostasis
Indications for surgical management:
(1) diameter of hematoma > 10 cm
(2) continued expansion of hematoma despite conservative management (application of pressure and ice packs)
(3) unexplained drop in hematocrit AND hypotension AND evidence of significant extraperitoneal hemorrhage into soft tissue as seen on imaging studies
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