Broad ligament hematoma is typically seen during cesarean section due to
rupture of branches of uterine and vaginal vessels and it’s rare to be seen
post-normal vaginal delivery. Addressing puerperal hematomas postpartum
presents considerable challenges for obstetric care providers. While hematomas
such as those affecting the vulva, vulvovaginal region, or paravaginal area are
frequently encountered, retroperitoneal hematomas are rare and notably pose a
greater risk to the life of the patient. The medical literature contains scant
case reports on retroperitoneal hematomas, with no consensus on a definitive
treatment approach. Pelvic arterial embolization has emerged as both a sensible
and increasingly preferred method for treating these hematomas recently, but
its application is contingent upon the patient maintaining hemodynamic
stability and the availability of a specialized interventional embolization
unit. In our case, we are presenting a very rare case of a 31-year-old primigravida
female with a history of in vitro fertilization pregnancy. She delivered a
normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced
multiple complicationsintrapartum, including preeclampsia and placental
abruption. These complications increased her risk of developing a broad
ligament hematoma.
Park, M. and Han, S.-S. (2011) A Case of Secondary Postpartum Hemorrhage with Shock Followed by Rupture of Progressive Retroperitoneal Hematoma through Left Upper Vaginal Wall. Korean Journal of Obstetrics & Gynecology, 54, 314-316.
https://doi.org/10.5468/KJOG.2011.54.6.314
[3]
Rafi, J. and Khalil, H. (2018) Maternal Morbidity and Mortality Associated with Retroperitoneal Haematomas in Pregnancy. JRSM Open, 9.
https://doi.org/10.1177/2054270417746059
[4]
Alturki, F., Ponette, V. and Boucher, L.M. (2018) Spontaneous Retroperitoneal Hematomas Following Uncomplicated Vaginal Deliveries: A Case Report and Literature Review. Journal of Obstetrics and Gynaecology Canada, 40, 712-715.
https://doi.org/10.1016/j.jogc.2017.08.045
[5]
Citil, A. (2023) Huge Retroperitoneal and Pelvic Hematoma Following VBAC (TOLAC): A Case Report. Obstetrics and Gynaecology Cases—Reviews, 10, Article No. 249. https://doi.org/10.23937/2377-9004/1410249
[6]
Chan, Y.C., Morales, J.P., Reidy, J.F. and Taylor, P.R. (2008) Management of Spontaneous and Iatrogenic Retroperitoneal Haemorrhage: Conservative Management, Endovascular Intervention or Open Surgery? International Journal of Clinical Practice, 62, 1604-1613. https://doi.org/10.1111/j.1742-1241.2007.01494.x
[7]
Redondo Villatoro, A., Azcona Sutil, L., Vargas Gálvez, D., Carmona Domínguez, E. and Cabezas Palacios, M.N. (2022) Diagnosis and Management of Postpartum Retroperitoneal Hematoma: A Report of 3 Cases. American Journal of Case Reports, 23, e935787. https://doi.org/10.12659/AJCR.935787
[8]
Hart, C., Bauersachs, R., Scholz, U., et al (2020) Prevention of Venous Thromboembolism during pregnancy and the puerperium with a special focus on women with hereditary thrombophilia or prior VTE-position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH). Hämostaseologie, 40, 572-590. https://doi.org/10.1055/a-1132-0750