{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:02:09Z","timestamp":1790766129039,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify risk factors for postpartum vaginal or vulvar hematoma and to determine clinical predictors of surgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A retrospective matched case\u2010control study was conducted at a tertiary, university\u2010affiliated center (2012\u20132024). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 147,045 deliveries, 57 women (0.04%) had postpartum hematoma; 170 matched controls were included. Mean diagnosis time was 1.0\u00a0\u00b1\u00a01.6 days post\u2010partum. Hematoma was associated with vacuum\u2010assisted delivery (21.1% vs. 4.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), episiotomy (24.6% vs. 2.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), second\u2010degree laceration (38.6% vs. 15.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), nulliparity, and lower body mass index (BMI;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In multivariable analysis, episiotomy (odds ratio [OR] 35.9, 95% confidence interval [CI] 5.6\u2013232.4), second\u2010degree laceration (OR 10.3, 95% CI 3.2\u201332.9), and vacuum delivery (OR 5.0, 95% CI 1.0\u201324.5) independently increased risk, whereas higher BMI (OR 0.69\/unit, 95% CI 0.55\u20130.85) and epidural analgesia (OR 0.33, 95% CI 0.12\u20130.93) were protective. The model's AUC was 0.83; a score \u22653 yielded 68% sensitivity and 79% specificity and a 97.8% negative predictive value, supporting its utility in ruling out hematoma and reducing surgical interventions. Among women with a hematoma, 26.3% required surgery. Mean time to surgery from diagnosis averaged 6.5\u00a0\u00b1\u00a03.8 h. Prolonged second stage (20% vs. 2.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05) was significantly associated with surgery, with trends toward more vacuum deliveries, no epidural, and greater hemoglobin decline. Postpartum hemorrhage and blood transfusion rates did not differ between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postpartum hematoma is rare but associated with vacuum delivery, episiotomy, second\u2010degree laceration, and low BMI, while epidural analgesia is protective. Early recognition supports timely management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70316","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T06:40:36Z","timestamp":1780728036000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical predictors of postpartum vaginal and vulvar hematomas and the need for surgical treatment"],"prefix":"10.1002","volume":"2","author":[{"given":"Itai","family":"Atar","sequence":"first","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2935-9194","authenticated-orcid":false,"given":"Einat","family":"Tako","sequence":"additional","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-3477","authenticated-orcid":false,"given":"Daniel","family":"Gabbai","sequence":"additional","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0941-2074","authenticated-orcid":false,"given":"Itamar","family":"Gilboa","sequence":"additional","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-4836","authenticated-orcid":false,"given":"Emmanuel","family":"Attali","sequence":"additional","affiliation":[{"name":"Lis Maternity Hospital Tel Aviv Sourasky Medical Center affiliated to the Gray Faculty of Medicine and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8545(21)00180-7"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2185\/jrm.2020\u2010046"},{"key":"e_1_2_11_4_1","first-page":"167","article-title":"Hematoma Vulvo\u2010Vaginal: Exceptional Etiology of Obstetrical Near Miss","volume":"19","author":"Dorland T. 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