Paravesical and broad ligament hematoma after vaginal delivery

Abstract

Abstract The management of puerperal hematomas after normal delivery has always been a challenging issue for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common; by contrast, retroperitoneal hematomas after normal delivery are uncommon and can be life-threatening. There are only few case reports about retroperitoneal hematomas in the literature and no standard management has yet to be established. Although pelvic arterial embolization has become a rational and popular method in the management of puerperal hematomas in recent years, it can only be performed if the patient is stable and interventional embolization unit is available. Moreover, the patient with hematoma usually presents with symptoms of shock; hence, rapid intervention is necessary. Considering the suggestions in the literature, management options of retroperitoneal hematomas include conservative management, incision and drainage of the hematoma, pelvic arterial embolization, and hysterectomy. Internal iliac artery ligation is a common mode of puerperal hematoma treatment; however, it has yet to be reported as a treatment modality in retroperitoneal puerperal hematoma. Thus, I present a very rare case of retroperitoneal hematoma after normal delivery, presenting with the symptoms of shock. Visualization and dissection of the retroperitoneal space was challenging in the hematoma site; however, the bleeding was successfully controlled with internal iliac artery ligation. Recovery of the patient was uneventful.