Puerperal vulvar edema and hematoma complicated by overuse of cold therapy—a report of two cases.

BACKGROUND: Puerperal vulvar edema and hematoma are rare complications of the postpartum period. The two conditions have similar risk factors and are known to occur together. The outcome of vulvar edema or hematoma is typically favorable, as both reabsorb with local perfusion mechanisms. Management recommendations vary, with recommendations based on limited evidence and anecdotal experience.

CASES: We report two cases, one of puerperal vulvar edema and one of puerperal vulvar hematoma, which became complicated by overuse of cold therapy during conservative management.

CONCLUSIONS: In both cases, initial conservative management failed. The common aspect was the overuse of ice packs directly applied to the perineum for comfort. Although studies indicate cold therapy should be applied to the perineum immediately postpartum for best pain relief results, there are no evidence-based indications for the duration of treatment. This report should serve to alert providers of the potential complication of excessive and prolonged ice application. We suggest clarification of conservative management to include the following: apply cool gel packs in short intervals, use cold therapy only within the first 24 to 48 hours postpartum, and no direct application of ice therapy.