Retroperitoneal haematomas in obstetrics: literature review

Abstract

Management of RH is complex and continues to improve with advancements in the investigative strategies, treatment options and critical care specialty. Further the authors highlight the importance of basic principles of clinical examination, the need for multidisciplinary input and the current trend in the management options.

Renal hematoma: An unusual cause of acute abdomen and fetal demise in severe Pre-Eclampsia

“…Angiography maybe required in some cases to localize the source of bleeding. [1,5] In the index case, in the immediate postpartum period, she developed hematuria and a palpable right lumbar mass; later developed fall in hematocrit and hypotension. She underwent repeat sonography and CT scan, which diagnosed the mass to be a perinephric hematoma.…”

“…[4] Clinicians may fail to differentiate the clinical picture from abruptio placentae, uterine rupture, twisted ovarian cyst, ectopic pregnancy, pyelonephritis, or nephrolithiasis. [5,8] In the index case, initially, the ultrasound picture was mistaken as retroplacental clot, and a diagnosis of toxemic abruption leading to acute renal failure and fetal demise was made.…”

“…[3][4][5] Laparotomy and nephrectomy may be required to control the hemorrhage. Spontaneous renal hematoma is treated by nephrectomy if the underlying cause is a tumor or if there is persistent bleeding and the patient has hemodynamic instability.…”

“…Selective arterial embolization is an alternative, which may help to avoid nephrectomy. [5] Trans-arterial embolization or stent-grafting of the bleeding vessels is effective in controlling hemorrhage and can be repeated if bleeding recurs (redo angio-embolization). [9] Angiography was done in our case with the aim to confirm the diagnosis and treat the ongoing hemorrhage by selective embolization.…”

“…[1][2][3][4] Renal hematoma may present with signs and symptoms, which may mimic the clinical presentation of abruptio placentae or rupture uterus. [2][3][4][5] We hereby report a case of spontaneous renal hematoma in a patient with severe pre-eclampsia who presented with acute abdomen and intrauterine fetal death. …”