Retroplacental hematoma: A case report

Abstract

Background: Retroperitoneal hematomas during pregnancy arising from ovarian vessels are rare. Thiscondition is usually associated with hemorrhagic shock and can lead to serious maternal-fetal morbidityor mortality. Carrying a pregnancy to term when the condition is diagnosed in early pregnancy istherefore not guaranteed.Case presentation: A 39-year-old para 4+1 presented at 26 weeks of gestation with a 2-day history ofright lower abdominal pain after a fall on her farm two weeks before admission. She was anemic, andabdominal ultrasound revealed a hypoechoic mass in the right lower quadrant of the abdomen, which,upon explorative laparotomy, turned out to be a large nonexpanding zone III retroperitoneal hematoma.Conservative management without opening the hematoma was performed, and she was serially imagedto assess the etiology and to rule out any further bleeding. The patient carried the pregnancy to term anddelivered vaginally. Postpartum exploration of the abdomen during tubal ligation revealed resolution ofthe hematoma.Discussion: Retroperitoneal hematomas can occur spontaneously or can be caused by blunt orpenetrating trauma. Patients mostly present with abdominal pain, hypovolemia, or anemia. Fordescriptive purposes, the retroperitoneum is divided into three zones: central, perirenal, and pelvic. Forspontaneous or blunt trauma hematomas in the pelvic zone, conservative management without openingthe hematoma is advised.Conclusion: Retroperitoneal hematoma should be a differential diagnosis in a patient presenting with anacute abdomen during pregnancy. Although associated with morbidity and mortality during pregnancy,patients with this condition can still carry their pregnancy to term and deliver normally.