# Massive Retroperitoneal Hematoma Following Vaginal Delivery: A Case Report and Review of Literature

## TL;DR

A rare case of massive retroperitoneal hematoma after vaginal delivery is reported, highlighting the importance of early diagnosis and multidisciplinary treatment.

## Contribution

This case report adds to the limited literature on retroperitoneal hematoma following childbirth and emphasizes diagnostic and management strategies.

## Key findings

- A 21-year-old woman developed severe hypotension and pelvic pain after vaginal delivery, leading to the discovery of a large pelvic hematoma.
- The patient required extensive blood product transfusions and surgical intervention to achieve hemostasis and recover fully.
- Retroperitoneal hematoma should be considered in postpartum patients with hemodynamic instability and no visible external bleeding.

## Abstract

Retroperitoneal hematoma is a rare but potentially life-threatening cause of concealed postpartum hemorrhage. Because bleeding is contained within the retroperitoneum, external blood loss may be absent, and symptoms may be nonspecific, resulting in delayed diagnosis. Rapid recognition and intervention are essential to reduce morbidity and mortality. We report a 21-year-old primigravida who developed severe hypotension and pelvic pain a few hours after an uncomplicated vaginal delivery with a small median episiotomy. Ultrasound revealed a 9 × 9 cm pelvic hematoma. Despite aggressive resuscitation, she required laparotomy, which demonstrated diffuse venous oozing from the retro pubic region without an arterial source. Hemostasis was achieved with combined vaginal and retroperitoneal packing. She required a total of 23 units of packed red blood cells, 18 units of fresh frozen plasma, five units of platelets, and two units of cryoprecipitate. She fully recovered following staged re-exploration and definitive closure. Retroperitoneal hematoma should be suspected in postpartum patients with hemodynamic instability and no external bleeding. A multidisciplinary approach and individualized management, including surgical packing, are critical for successful outcomes.