Rare Perineal Hematoma in Pregnancy: Insights and Prevention Strategies

A rare case of spontaneous bilateral perineal hematoma during pregnancy was reported, along with a detailed literature review to provide insights for clinical practice. The patient, a 33-year-old primigravida, began self-administered perineal massage at 36 weeks of gestation. However, at 39^+5 weeks, bilateral spontaneous perineal hematomas developed before delivery, leading to a left mediolateral episiotomy during childbirth. Following conservative postpartum treatment, the hematomas gradually resolved, and the wound healed well. Eighteen months later, the patient had another vaginal delivery without recurrence of hematoma or laceration.

Spontaneous perineal hematoma during pregnancy is a rare occurrence, usually attributed to factors such as increased vascular fragility, hormonal fluctuations, venous congestion, and external forces. The introduction of perineal massage during pregnancy aims to reduce perineal tears and episiotomy rates. However, improper massage techniques may lead to tissue injuries. In this case, the patient’s perineal massage, performed by her spouse, might have contributed to the development of bilateral hematomas. Proper training and guidance on perineal massage are crucial to avoid inadvertent injuries.

Literature review highlights the scarcity of reports on spontaneous perineal hematomas during pregnancy, with most cases being individual studies. Various cases have been reported, emphasizing the importance of timely recognition and treatment to prevent complications. The management of perineal hematomas depends on factors like size, clinical severity, and bleeding risk, with options ranging from conservative measures to surgical intervention.

Preventive strategies, including regular antenatal visits, proper perinatal care, and correct perineal massage techniques, are essential to minimize the risk of spontaneous perineal hematomas. Moreover, close monitoring during labor, careful perineal handling, and early detection of hematomas are crucial for ensuring maternal and fetal safety. The patient’s favorable outcomes in subsequent deliveries underscore the importance of vigilant management and prevention strategies in cases of spontaneous perineal hematoma during pregnancy.