She did not remember her last normal menstrual period (LNMP) but claimed to be amenorrheic for 9 months. This is a 28-year-old para IV mother from rural Ethiopia who gave birth to an alive female neonate weighing 3000 g at home 24 hours before presentation. Here we present, a case of postpartum vulvar hematoma as the cause of MNM. Postpartum vulvar hematomas cause maternal morbidities such as anemia, postpartum hemorrhage, superinfection, necrotizing fasciitis, prolonged hospitalization, and need for transfusion. Damage to labial branches of the internal pudendal artery in this vascular network easily initiates hematoma development. This vulvar vasculature commonly develops varicosities during pregnancy, especially in parous women, due to increased venous pressure created by the increasing weight of the uterus. The venous drainage is provided by labial veins, and labial veins drain into the external and internal pudendal veins. The vulva is soft tissue mainly composed of smooth muscle and loose connective tissue and is supplied by branches of the pudendal artery. Ī vulvar hematoma is a collection of blood in the vulva. Vulvar hematoma is among genital tract traumas that cause PPH. The major causes of PPH are uterine atony, genital tract laceration, retained tissues (placenta and membranes), and coagulopathy. One of the causes of MNM is postpartum hemorrhage (PPH). In Ethiopia, for every woman who dies from pregnancy-related causes, 12–21 others experience maternal near miss (MNM). According to the World Health Organization (WHO), maternal near miss (MNM) is defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. "Impact of a Rapid Second Stage of Labor on Subsequent Pregnancy Outcomes ".
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