Diagnosis and Management of Postpartum Retroperitoneal Hematoma: A Report of 3 Cases

Case series Patients: Female, 35-year-old • Female, 28-year-old • Female, 29-year-old Final Diagnosis: Retroperitoneal hematoma Symptoms: Anemia • arterial hypotension • signs of hypovolemic shock • sudden onset abdominal pain Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology OBJECTIVE: Unusual clinical course BACKGROUND: The retroperitoneal hematoma is a very rare entity in obstetrics. A type of obstetric hematoma that extends into the retroperitoneal space, this hematoma usually occurs after laceration of the uterine artery, after uterine rupture, or by extension of a vaginal hematoma. Although the hematoma usually manifests as intense abdominal pain, sometimes the clinical signs can go unnoticed. This is the main reason it is important to report the cases in which retroperitoneal hematomas occur. In addition to clinical suspicion, experience in management can also help improve maternal morbidity and mortality from this cause. CASE REPORTS: We present a series of 3 clinical cases in which retroperitoneal hematomas occurred after instrumental deliveries. The 3 clinical cases described took place before the COVID-19 pandemic. In the first 2 deliveries, a vacuum was used, while in the third delivery, spatulas were used. CONCLUSIONS: Our findings showed that suspicion is essential in patients with symptoms of nonspecific pain, as well as in patients with anemia that causes hemodynamic instability in the immediate postpartum period. The use of early computed tomography angiography in hemodynamically stable patients is essential to reach a diagnosis and to determine if the patient can be treated by embolization of the bleeding vessel.