Question:medium

A woman develops a painful, tense, fluctuant swelling in the vulvovaginal region following a forceps delivery, along with difficulty in passing urine. The most likely diagnosis is:

Show Hint

Acute, tense, painful swelling right after forceps = blood collecting in the tissue planes.
Updated On: Jun 25, 2026
  • Vulvovaginal hematoma
  • Urethral diverticulum
  • Cervical tear
  • Local infection / abscess
Show Solution

The Correct Option is A

Solution and Explanation

Work backward from the timeline. The swelling appears immediately after a forceps delivery, which points to trauma rather than infection or a developmental lesion.

Forceps blades can tear small vessels in the paravaginal connective tissue while the overlying mucosa stays intact. The escaping blood is trapped in a confined plane, so it forms a tense, exquisitely tender, fluctuant lump. Because the mass lies adjacent to the lower urinary tract, its pressure on the urethra explains the difficulty in passing urine.

Contrast the distractors: a urethral diverticulum is chronic with post-micturition dribbling; a cervical tear bleeds briskly from the canal rather than producing a vulval lump; an abscess needs days and brings fever and redness. None match an instant, painful, fluctuant post-forceps swelling.

$Acute + painful + fluctuant + post\text{-}instrumental \Rightarrow$ a blood collection.

\[\boxed{\text{Vulvovaginal (puerperal) hematoma}}\]
Was this answer helpful?
0