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

Acreman, Melissa; Sainani, Mahesh

doi:10.1136/bcr-2018-225980

Cited by 6 publications

(6 citation statements)

References 4 publications

(6 reference statements)

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“…Patients who deteriorate while on conservative management will need immediate surgical exploration [ 1 ]. Most of the patients reported required surgical intervention as they were hemodynamically unstable [ [2] , [3] , [4] , 6 , 7 ] and the source of bleeding needed to be identified and hemostatic sutures applied to stop the bleeding.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report

Zon

Afendi

Ismail

et al. 2022

Case Reports in Women's Health

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Section: Discussionmentioning

confidence: 99%

Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report

Zon

Afendi

Ismail

et al. 2022

Case Reports in Women's Health

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“…The failure of incision and drainage in three cases, with the need for subsequent transcatheter arterial embolisation (TAE) described by Baruch et al [ 3 ] and Villella et al [ 4 ] and laparotomy in one by Singh et al [ 5 ], highlights the potential difficulties in accessing and achieving haemostasis in this large potential space. Laparotomy and radiologically guided drainage have also been described as primary approaches [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Large concealed paravaginal haematoma: A case report of an occult postpartum haemorrhage

Stobie

Krishnan

2021

Case Reports in Women's Health

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Paravaginal haematomas are common but rarely do they cause severe postpartum haemorrhage. While surgical evacuation is classically recommended for large haematomas, conservative management may be an appropriate strategy. We present the case of a 30-year-old primiparous woman with a large paravaginal haematoma causing a postpartum haemorrhage managed conservatively. The patient became hypotensive to 80/40 mmHg three and a half hours after forceps delivery, despite minimal vaginal bleeding. On examination she had a palpable mass at the right vaginal wall and uterine fundus deviated to the right, above the umbilicus. A computerised tomography examination of the pelvis demonstrated two paravaginal haematomas, the largest measuring 7 cm × 8 cm × 12 cm, extending superiorly into the supralevator and extraperitoneal space. The patient's haemoglobin fell from 13.2 g/dL to 7.1 g/dL. She was managed conservatively with analgesia, intravenous fluid resuscitation and one unit of packed red blood cells, and was discharged home three days postpartum. This case supports the conservative management of even large paravaginal haematomas, which may extend into the supralevator space, making surgical evacuation technically difficult.

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“…Literature reviews have revealed that the incidence of puerperal hematoma varies from 1:309 to 1:1500 deliveries. 2 Incidents can occur immediately after delivery or during the puerperal period. 3 Puerperal hematomas are mainly located on the vulva, vagina, broad ligament and rarely but possible happen in the retroperitoneal area.…”

Section: Introductionmentioning

confidence: 99%

Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report

Vidhisvara

Widiarsa²,

Helena

et al. 2021

Intisari Sains Medis

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Background: Parametrial hematoma is collection of blood located in the parametrial area, which is a type of hematoma that can occur in the pelvic cavity. Postpartum hematoma is a rare but life-threatening complication of childbirth. Common risk factors to developing parametrial hematomas include multiple pregnancies, traumatic deliveries, operative vaginal delivery, prolonged labour, manual removal of placenta, inadequate hemostasis at Caesarean section, pre-eclampsia, and anticoagulation therapy. We reported a rare case of parametrial hematoma post-craniotomy and curettage of a fetus with intrauterine fetal death (IUFD) in a 28-year-old pregnant woman 24 weeks into her fourth pregnancy. Case report: A pregnant woman with 24 weeks gestation age came to emergency room with complaints of abdominal pain and bloody discharge without clear fluids 9 hours prior. She was diagnosed with preterm delivery and was given tocolytic. The following day, ultrasound examination was done and fetal heart rate (FHR) was not found, suggesting an intrauterine fetal death (IUFD). Termination was carried out with oxytocin induction but due to maternal exhaustion, pain, and lack of cooperation, a craniotomy was done in operating room followed by curettage. Twenty-four hours after curettage, patient complained of an acute lower right abdominal pain and ultrasound showed a complex mass in right adnexa measuring 8 x 8 cm, suggesting a right adnexal hematoma with a differential diagnosis of a right tubo-ovarian abscess. The patient’s haemoglobin was found to decrease to 6.0 g/dl. A laparotomy was performed and a hematoma was found in the right parametrium without active bleeding. Conclusion: Parametrial hematoma is a rare disease that can occur due to trauma (in labor) or spontaneously due to abnormalities of the uterine arteries that supply blood to the uterus. The patient present in this case report had acute abdominal pain with decreased haemoglobin without signs of bleeding after an operative vaginal birth which may or may not be the cause of the parametrial hematoma due to limitations of examination on the patients. Further observation of similar cases will be required to determine the association between parametrial hematoma and operative vaginal birth.

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

Cited by 6 publications

References 4 publications

Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report

Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report

Large concealed paravaginal haematoma: A case report of an occult postpartum haemorrhage

Parametrial hematoma following fetal craniotomy and curettage in intrauterine fetal death: a case report

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