Clinical predictors of postpartum vaginal and vulvar hematomas and the need for surgical treatment.

Objective: To identify risk factors for postpartum vaginal or vulvar hematoma and to determine clinical predictors of surgical intervention. Study design: A retrospective matched case-control study was conducted at a tertiary, university-affiliated center (2012-2024). Women diagnosed with vaginal or vulvar hematoma (cases) during the postpartum hospitalization were matched in a 1:3 ratio by maternal and gestational age to controls. Independent risk factors were identified using conditional logistic regression with a Cox regression model. A risk score was derived from the multivariable model, and ROC analysis was used to assess performance. A subgroup analysis evaluated predictors of surgery. Results: Among 147,045 deliveries, 57 women (0.04%) had postpartum hematoma; 170 matched controls were included. Mean diagnosis time was 1.0 ± 1.6 days post-partum. Hematoma was associated with vacuum-assisted delivery (21.1% vs. 4.7%, Conclusion: Postpartum hematoma is rare but associated with vacuum delivery, episiotomy, second-degree laceration, and low BMI, while epidural analgesia is protective. Early recognition supports timely management.