Maternal deaths associated with postpartum vulvar edema

Reported are three maternal deaths in four patients who presented with a similar syndrome following a normal antepartum course and normal labor and delivery managed by regional or local anesthesia and midline or proctoepisiotomy. Beginning about the second postpartum day, the patients developed unilateral perineal edema and induration which progressed to generalized vulvar, vaginal, perineal, and gluteal edema and induration. These patients developed marked leukocytosis, fever, and ultimately vascular collapse; three of them died. The one patient who survived had a similar course except for vascular collapse. Unilateral vulvar induration and edema associated with fever and marked leukocytosis are ominous signs. Aggressive treatment should include the use of multiple antibiotic, crystaloid, colloid, and steroid drugs and appropriate monitoring. By this report we hope to bring attention to this rare but lethal syndrome.