Puerperal hematoma is an uncommon complication of childbirth with a potential for serious morbidity and possible mortality. Prevention, using good surgical technique with attention to hemostasis in the repair of lacerations and episiotomies, should limit the occurrence of this complication. Puerperal hematomas, however, are not unavoidable. Thus, one must be alert to the possibility so that the hematoma can be diagnosed early and treated aggressively. This includes correcting hypovolemia and intervening with active surgical management if the hematoma is large or expanding.