Background: Vulvar hematoma formation during a spontaneous vaginal birth is rare. Although conservative management or observation is an option, complications, including delivery obstruction and excessive vaginal bleeding, may occur.
Case: A woman presented in active labor with an enlarging vulvar hematoma reaching the size of a softball. Spontaneous vaginal delivery occurred with an "explosion" of the hematoma and excessive blood loss. To obtain hemostasis, the hematoma cavity was explored and the bleeding points sutured.
Conclusion: With a large intrapartum vulvar hematoma, the risk of rupture exists. If it occurs, delivery should be accomplished expediently, hemostasis achieved rapidly and blood loss monitored closely.