Effects of vaginal lichen planus on pregnancy

Introduction: Lichen planus is an inflammatory condition that can affect the vulva and vagina. Although more common in women over 50 years of age, lichen planus can affect younger women and complicate pregnancy. During pregnancy, lichen planus can cause vaginal irritation, antepartum bleeding, and postpartum hemorrhages. It is imperative to maintain good control of the disease during pregnancy with topical corticosteroids. Case Report: A 35-year-old female with a history of vaginal lichen planus, on vaginal hydrocortisone, presented to the labor and delivery ward in the active stage of labor. She proceeds with a vaginal delivery that is followed by a postpartum hemorrhage requiring a blood transfusion. The postpartum hemorrhage was secondary to bleeding from the vaginal mucosa that was intolerant to sutures. Bleeding was then controlled with topical hemostatic agents as well as vaginal packing. Conclusion: Uncontrolled vaginal lichen planus can be associated with postpartum hemorrhage at the time of delivery. Some providers may recommend a cesarean section to prevent these outcomes; however, instead it is recommended to focus on adequate control of the disease prior to delivery and to proceed with a vaginal delivery. Standard regimens of topical corticosteroids can be safe and effective at preventing flares of lichen planus in pregnancy. In the event of a postpartum hemorrhage secondary to lichen planus, topical hemostatic agents and vaginal packing should be implemented as means to minimize blood loss.