Maternal morbidity and mortality associated with retroperitoneal haematomas in pregnancy

Abstract

Retroperitoneal haematomas in obstetrics are uncommon. The causes and pathogenesis of retroperitoneal haematomas lack clarity and the aim of this review is to recognise retroperitoneal haematomas as a separate entity from commonly seen vaginal and pelvic haematomas. It is time to raise awareness among obstetricians to recognise retroperitoneal haematomas as an important cause of maternal morbidity and mortality which requires high clinical suspicion and multidisciplinary input. As retroperitoneal haematomas are rare but can cause serious threat to maternal wellbeing, resources should be directed towards their management. Existing guidelines of maternal collapse and morbidity during pregnancy and puerperium need to include retroperitoneal haematomas as one of the important causes of maternal shock or morbidity. New learning pathways should be opted for to increase awareness of retroperitoneal haematomas among obstetricians enabling them to reflect on their implications while managing retroperitoneal haematomas. Management of retroperitoneal haematomas is complex and continues to improve with advancements in the investigative strategies, treatment options and multidisciplinary involvement.

Retzius space haematoma as a rare cause of concealed retroperitoneal postpartum haemorrhage following spontaneous vaginal delivery

“…Haematoma in the Retzius space is thought to occur due to rupture of the plexus of Santorini, the vessels of which may be weakened during pregnancy and damaged during descent and delivery of the fetal head 2. Various coagulopathies are also implicated as predisposing factors, and indeed this patient had mild haemophilia A which likely contributed to the extent of haematoma and the failure to control haemorrhage with haemostatic sutures alone 6.…”

“…They are most commonly caused by splenic artery rupture, renal artery aneurysms, ruptured renal angiomyolipoma and ovarian artery rupture 2. Retzius space haematoma after spontaneous vaginal delivery, as described in this case, is an exceptionally rare cause of retroperitoneal haemorrhage and poses difficulty in both diagnosis and management.…”

“…Retroperitoneal haematomas are a rare cause of concealed postpartum haemorrhage and may be difficult to diagnose 2. They are most commonly caused by splenic artery rupture, renal artery aneurysms, ruptured renal angiomyolipoma and ovarian artery rupture 2.…”

Retroperitoneal Hematoma after Birth due to Iliac Vascular Injury: a Case Report and Review of Literature

“…It may cause maternal morbidity and mortality due to its rapid course and late diagnosis [9]. In the literature, 21 cases of obstetric RPH have been reported in the last 12 years and one of them has been diagnosed in postmortem period [10]. Similarly, RPH may cause maternal mortality despite active resuscitation [11].…”

Ultrasound of a late onset postpartum broad ligament haematoma

“…For example, both CT and MRI scans are useful in identifying deep extraperitoneal haematoma and delineating the extent of haematoma 4,9 . Moreover, CT angiography can sometimes be used to reveal the site of the bleed and demarcate the contrast outside the blood vessels 14 . However, CT scans present risks through iodine contrast administration and radiation exposure.…”