vaginal hematoma...

  1. about 1 and 1/2 hours post nsvd, with midline epis, pt developed a not obvious vaginal hematoma. she was perfectly comfortable and happy, but all of a sudden started complaining of excrutiating pain in her rectum. from external inspection it looked like nothing was wrong... i did not feel comfortable and called the resident to come and evaluate. which he refused to do. until after i then called the attending, and then called back the resident.... when examined vaginally there was a 7cm hematoma. was i wrong not to examine her vaginally? it was a crazy night on floor, and i consulted with senior nurse as to what to do and she agreed that resident should have been the one to examine, not me. what would you have done in situation?? pt had an evacuation and breakdown and repair of epis, and recovered well....
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    About elleRN

    Joined: Sep '02; Posts: 42
    L&D RN


  3. by   mark_LD_RN
    hard to say being i was not there. but i probably would have checked her myself.
  4. by   webbiedebbie
    I would have checked her also.
  5. by   littlemack
    A close friend delivered 2 weeks ago and she also had a huge vaginal wall hematoma that resulted in going to the OR for a repair. She had a HCT of 17 at discharge and the repair ruptured on the day of discharge.
    I would support any nurse that inspected a perineum, as we have to advocate for the patients.
  6. by   canoehead
    Hey, just to come in on the other side...

    she had a pt with excruciating pain and she examined her as much as she felt comfortable and then called the MD. She expected the res to come, but when he didn't should that have increased her comfort level. I'm not suggesting that she leave the pt, but move up the chain of command until someone else came or she got more information on the pt that made her feel safe in doing a more in depth exam.

    It is possible that poking around without knowing what you were looking for could rupture the hematoma and cause a big bleed. Not to mention the screaming pt as the nurse goes digging around a painful area. I think that just the pain control issue was worth holding on the exam while you get a doc in to help.
  7. by   SmilingBluEyes
    I second canoehead. I would have called the doctor after careful visual inspection with a perilamp revealed nothing. To me, something this potentially complicated deserves M.D. attention and nothing less. I am fortunate; if I do call an M. D. they will come to check it out. Some are not so lucky and have to "convince" them there is a problem. Hope the patient's recovery is complete.