Association of Contrast-Enhanced CT–Detected Extravasation with Transfusion Requirements in Vulvovaginal Hematoma: A Single-Center Exploratory Retrospective Study

Background and Objectives: To evaluate whether contrast extravasation on contrast-enhanced computed tomography (CE-CT) is associated with hemorrhage severity, transfusion requirements, and treatment strategies in patients with postpartum vulvovaginal hematoma. Materials and Methods: This single-center retrospective cohort study included 21 patients with vulvovaginal hematoma who underwent CE-CT between 2018 and 2024. Extravasation-positive cases were defined as those demonstrating arterial-phase contrast leakage that persisted on delayed-phase imaging. Clinical variables, including blood loss, laboratory findings, transfusion requirements, and management strategies (conservative treatment, surgery, and transcatheter arterial embolization) were compared between extravasation-positive and -negative groups. Results: Maternal and obstetric characteristics were similar between groups, except for maternal age (32.5 vs. 30 years, p = 0.013). The extravasation-positive group received significantly more red blood cell (RBC) transfusions (median: 13 vs. 6 units, p = 0.02) and fresh frozen plasma (14 vs. 4 units, p = 0.035) and had a higher frequency of massive transfusions (>10 RBC units). Estimated blood loss was higher in the extravasation-positive group (median: 4772 vs. 1945 g), although this difference was not statistically significant. Hematoma volume and location were not associated with extravasation. Clinical success was achieved in all 13 transcatheter arterial embolization (TAE) procedures (100%). Conclusions: CT-detected extravasation was associated with greater transfusion requirements and may provide clinically useful information as an adjunct to overall clinical assessment when considering hemostatic management in patients with vulvovaginal hematoma. Early CE-CT evaluation and prompt consideration of TAE when extravasation is identified may potentially contribute to improved hemostatic management.