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Retroperitoneal haematomas in obstetrics: literature review

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

There is paucity of literature on retroperitoneal haemorrhage/haematomas (RH) as these cases are extremely rare in obstetrics. Experience is available mostly from case reports and therefore the incidence of RH in obstetrics is unknown.

Methods

Literature search in Medline/Pubmed and Google scholar using MeSH; aneurysm, haematoma, haemorrhage, obstetrics and retroperitoneal.

Aetiology and pathogenesis

This article discusses aetiology, pathogenesis, diagnostic difficulties and dilemmas, as well as misleading symptoms that often mimic common clinical conditions.

Diagnosis and Management

Management of RH is complex and continues to improve with advancements in the investigative strategies, treatment options and critical care specialty. Further the authors highlight the importance of basic principles of clinical examination, the need for multidisciplinary input and the current trend in the management options.

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Abbreviations

RH:

Retroperitoneal haemorrhage/haematomas

RAA:

Renal artery aneurysm

AML:

Angiomyolipoma

BMI:

Body mass index

References

  1. Chan YC, Morales JP, Reidy JF, Taylor PR (2008) Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 62(10):1604–1613

    Article  CAS  PubMed  Google Scholar 

  2. Bhosale A, Fonseca M, Nandanwar YS (2008) A rare case of retroperitoneal haematoma complicating pregnancy. Bombay Med J 50(2):316–317

    Google Scholar 

  3. Kim S, Gnanasekaran I, Quilatan RL (2006) Unusual cause of acute renal failure in pregnancy: ruptured renal artery aneurysm. Resident Staff Physician 52:9

    Google Scholar 

  4. Vengadasalam D (1989) Maternal mortality—a review at the department of obstetrics and gynaecology: Alexandra Hospital, Singapore. Sing Med J 30:561–564

    CAS  Google Scholar 

  5. Hunsaker DM, Turner S, Hunsaker JC 3rd (2002) Sudden unexpected death resulting from splenic artery aneurysm rupture: two case reports of pregnancy related fatal rupture of splenic artery aneurysm. Am J Forensic Med 23:338–341

    Article  Google Scholar 

  6. Loke SS, Bullard MJ, Liaw SJ, Liao HC (1995) Splenic artery aneurysm rupture in pregnancy—a review and case report. Changgeng Yi Xue Za Zhi 18(2):166–169

    CAS  PubMed  Google Scholar 

  7. Kurdoglu M, Onan MA, Turp A, Kurdoglu Z (2008) Spontaneous illiopsoas haematoma during heparin anticoagulation: cause of fetal loss. J Obstet Gynaecol 28(5):543–544

    Article  CAS  PubMed  Google Scholar 

  8. Soliman KB, Shawky Y, Abbas MM, Ammary M, Shaaban A (2006) Ruptured renal artery aneurysm during pregnancy, a clinical dilemma. BMC Urol 6:22

    Article  PubMed  Google Scholar 

  9. Asfar FA, Saber M, Dhar PM, Awadhi NA (2005) Rupture of splenic artery aneurysm during labour: a case report of maternal and foetal survival. Med Princ Pract 14:53–54

    Article  PubMed  Google Scholar 

  10. Lewis EL, Palmer JM (1985) Renal angiomyolipoma and massive retroperitoneal haemorrhage during pregnancy. West J Med 143(5):675–676

    CAS  PubMed  Google Scholar 

  11. Raft J, Lalot JM, Meistelman C, Longrois D (2006) Renal angiomyolipoma rupture during pregnancy. Gynecol Obstet Fertil 34(10):917–919

    Article  CAS  PubMed  Google Scholar 

  12. Daizo O, Shutaro M, Tetsuya T, Hitoshi I, Kensaku N, Susumu M (1999) Spontaneous rupture of a renal angiomyolipoma in pregnancy: a case report. Acta Urologica Japonica 45(6):423–425 (Abstract; article in Japanese)

    Google Scholar 

  13. Yamashita Y, Torashima M, Harada M, Yamamoto H, Takahashi M (1993) Postpartum extraperitoneum haematoma: imaging finding. AJR 161:805–808

    CAS  PubMed  Google Scholar 

  14. Singh J, Basu S, Aich A, Bhal PS (2008) Spontaneous ischiorectal and retro-peritoneal haematoma after normal vaginal delivery. J Obstet Gynaecol 28(8):798–799

    Article  CAS  PubMed  Google Scholar 

  15. Hillemanns P, Knitza R, Muller-Hocker J (1996) Rupture of splenic artery aneurysm in a pregnant patient with portal hypertension. Am J Obstet Gynecol 174:1665–1666

    Article  CAS  PubMed  Google Scholar 

  16. Shahabi S, Jani J, Masters L, Cobin L, Greindl J (2000) Spontaneous rupture of a splenic artery aneurysm in pregnancy: report of two cases. Acta Chir Belg 100:231–233

    CAS  PubMed  Google Scholar 

  17. O’Grady JP, Day EJ, Toole AL, Paust JC (1977) Splenic artery aneurysm rupture in pregnancy. Obstet Gynecol 50:627–630

    PubMed  Google Scholar 

  18. Hunka D, Csordas T, Domany Z (1991) Rupture of the splenic artery aneurysm during pregnancy. Acta Chir Hung 32:77–82

    CAS  PubMed  Google Scholar 

  19. Cohen S, Cashoan A, Burger R (1972) Spontaneous rupture of renal artery aneurysm during pregnancy. Obstet Gynecol 39:897–901

    CAS  PubMed  Google Scholar 

  20. Rijbroek A, van Dijk HA, Roex AJ (1994) Rupture of renal artery aneurysm during pregnancy. Eur J Vasc Surg 8:375–376

    Article  CAS  PubMed  Google Scholar 

  21. Prabulos AM, Chen HH, Rodis JF et al (1997) Angiographic embolisation of a ruptured renal artery aneurysm during pregnancy. Obstet Gynecol 90:663–665

    Article  CAS  PubMed  Google Scholar 

  22. Pilskin MJ, Dresner ML, Hassell LH et al (1990) A giant renal artery aneurysm diagnosed post partum. J Urol 144(6):1459–1461

    Google Scholar 

  23. Meabed AH, Onuora VC, Al Turki M, Koko AH, Al Jawini N (2002) Rupture of a renal artery aneurysm in pregnancy. Urol Int 69:72–74

    Article  PubMed  Google Scholar 

  24. Yang JC, Hye RJ (1996) Ruptured renal artery aneurysm during pregnancy. Ann Vasc Surg 10(4):370–372

    Article  CAS  PubMed  Google Scholar 

  25. Lacroix H, Bernaerts P, Nevelsteen A, Hanssens M (2001) Ruptured renal artery aneurysm during pregnancy: successful ex situ repair and autotransplantation. J Vasc Surg 33:188–190

    Article  CAS  PubMed  Google Scholar 

  26. Cohen JR, Shamash FS (1987) Ruptured renal artery aneurysms during pregnancy. J Vasc Surg 6(1):51–59

    Article  CAS  PubMed  Google Scholar 

  27. Ghanavati F, Lavin A (2003) Ruptured renal artery aneurysm in a pregnant woman with solitary kidney. J Obstet Gynaecol 23:564–566

    Article  CAS  PubMed  Google Scholar 

  28. Moore HC (1965) Marfan syndrome, dissecting aneurysm of the aorta, and pregnancy. J Clin Path 18:277–281

    Article  CAS  PubMed  Google Scholar 

  29. Yamada K, Takahashi R, Hamatani K (2002) Hemorrhagic shock due to ruptured left common iliac artery aneurysm during pregnancy. J Anaesth 16(4):342–344

    Google Scholar 

  30. Cardia G, Iusco D, Melino R, Neri V, Nacchiero M (2002) Unusual pregnancy-related vascular emergency. Am J Perinatol 19(5):241–246

    Article  PubMed  Google Scholar 

  31. Guillem P, Bondue X, Chambon JP, Lemaitre L, Bounoua F (1999) Spontaneous retroperitoneal haematoma from rupture of an aneurysm of the ovarian artery following delivery. Ann Vasc Surg 13(4):445–448

    Article  CAS  PubMed  Google Scholar 

  32. Banas T, Boryczko M, Durzvnska-Urbaniec J (2004) Intraperitoneal hemorrhage due to the rupture of right ovarian artery in the second day of puerperium. Ginekol Pol. 75(9):729–732 (Abstract; article in Polish)

    PubMed  Google Scholar 

  33. Poilblanc M, Winer N, Bouvier A, Gillard P, Boussion F, Aube C, Descamps P (2008) Rupture of an aneurysm of the ovarian artery following delivery and endovascular treatment. Am J Obstet Gynecol 199(4):e7–e8

    Article  PubMed  Google Scholar 

  34. Mojab K, Rodriguez J (1977) Postpartum ovarian artery rupture with retroperitoneal haemorrhage. Am J Roentgenol 128:695–696

    CAS  Google Scholar 

  35. Becker R, Kowalsky BL, Hatzmann W (2002) Rupture of the uterine artery after spontaneous delivery with unusual course in childbed. Z Geburtshilfe Neonatal 206(3):107–113 (Abstract; article in German)

    Article  CAS  Google Scholar 

  36. Wu HM, Shih CH (1965) Spontaneous normal delivery complicated with rupture of uterine vessel and retroperitoneal haematoma. Taiwan Yi Xue Hui Za Zhi 64(6):336–339

    CAS  PubMed  Google Scholar 

  37. Department of Health (1998) Why mothers die: report on confidential enquiries into maternal deaths in the United Kingdom 1994-1996. Chapter 11. Other indirect deaths. Diseases of the circulatory system (Aneurysms). Available via: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_4009520.Chapter 11. Accessed 10 Aug 2009

  38. Harma M, Harma M, Ozturk A, Gungen N (2004) Spontaneously resolved post-caesarean giant retroperitoneal haematoma: a case report. Int J Gynecol Obstet 3(2)

  39. Cederqvist LL, Birnbaum SJ (1980) Rupture of the uterus after mid trimester prostaglandin abortion. J Reprod Med 25(3):136–138

    CAS  PubMed  Google Scholar 

  40. Russ WC (1979) Ultrasonic diagnosis of retroperitoneal haematoma following therapeutic abortion. Med Ultrasound 3(1):33–34

    CAS  PubMed  Google Scholar 

  41. Maternal Mortality Studies from Canadian Medical Association (1965) Missed abortion, rupture of the uterus and retroperitoneal haemorrhage. Can Med Assoc J 93:758–759

    Google Scholar 

  42. Rafi J, Muppala H (2008) Conservative management of massive puerperal spontaneous onset retroperitoneal haematoma following normal vaginal delivery. J Obstet Gynaecol 28(1):105–106

    Article  CAS  PubMed  Google Scholar 

  43. Sherer DM, Dayal AK, Schwartz BM, Oren R, Abulafia O (1999) Extensive spontaneous retroperitoneal haemorrhage: an unusual complication of heparin anticoagulation during pregnancy. J Maternal Fetal Med 8:196–199

    CAS  Google Scholar 

  44. Kurzel RB, Au AH, Rooholamini SA (1996) Retroperitoneal haematoma as a complication of pudendal block–diagnosis made by computed tomography. West J Med 164:523–525

    CAS  PubMed  Google Scholar 

  45. Rana A, Gurung G, Bista KD, Singh KP, Ghimire RK (2005) A rare presentation of post hysterectomy retroperitoneal haematoma. J Inst Med 27:68–70

    Google Scholar 

  46. Kontos S, Politis V, Fokitis I, Lefakis G, Koritsiadis G, Simaioforidis V, Kachrilas S, Chatziplis E, Koritsiadis S (2008) Rupture of renal angiomyolipoma during pregnancy: a case report. Cases J 1:245

    Article  PubMed  Google Scholar 

  47. Yanai H, Sasagawa I, Kubota Y, Ishigooka M, Hashimoto T, Kaneko H, Nakada T (1996) Spontaneous haemorrhage during pregnancy secondary to renal angiomyolipoma. Urol Int 56(3):188–191

    Article  CAS  PubMed  Google Scholar 

  48. Palmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME (2006) Femoral neuropathy following retroperitoneal haemorrhage: case series and review of literature. Ann Vasc Surg 20:536–540

    Article  Google Scholar 

  49. Brodey PA, Gabbay RJ, Jacobson JB (1982) Retroperitoneal haemorrhage during pregnancy secondary to renal angiomyolipoma. Urol Radiol 4(4):255–257

    Article  CAS  PubMed  Google Scholar 

  50. Lee SY, Huang YC (2008) Isolated renal angiomyolipoma presented as retroperitoneal haemorrhage: a case report. J Emerg Crit Care Med 19(3):119–125

    Google Scholar 

  51. Chiarugi M, Martino MC, Pucciarelli M, Decanini L, Vignali C (2008) Recurrent retroperitoneal haemorrhage in a patient with tuberous sclerosis complex: a case report. Cases J 1:424

    Article  PubMed  Google Scholar 

  52. Storm DW, Mowad JJ (2006) Conservative management of a bleeding renal angiomyolipoma in pregnancy. Obstet Gynecol 107(2):490–492

    PubMed  Google Scholar 

  53. Bartha Rasero JL, Bedoya Bergua C, Diaz Cano S, Sanchez Ramos J (1993) Renal cell adenocarcinoma and massive retroperitoneal haemorrhage during pregnancy. Arch Esp Urol 46(5):421–423 Abstract; article in Spanish

    CAS  PubMed  Google Scholar 

  54. Plaus WJ (1987) Retroperitoneal haemorrhage presenting as a ruptured ectopic pregnancy. Ann Emerg Med 16(12):1398–1400

    Article  CAS  PubMed  Google Scholar 

  55. Philips CK, Lepor H (2006) Spontaneous retroperitoneal haemorrhage caused by segmental arterial mediolysis. Rev Urol 8(1):36–40

    Google Scholar 

  56. Lee S, Park SK, Jin GY, Kim JH, Cho SN, Kang SK, Kim W (2003) Spontaneous renal subcapsular haematoma and acute renal failure complicated by severe pre-eclampsia. Nephrol Dial Transplant 18:625–626

    Article  PubMed  Google Scholar 

  57. Jun EJ, Kim JO, Lim SJ, Jeon HK, Kim CJ, Han CH, Yoon SA, Bang BK (2000) Spontaneous renal subcapsular haematoma in a patient with severe preeclampsia. Nephron 86:515–516

    Article  CAS  PubMed  Google Scholar 

  58. Kably IM, Chikhaoui N (2003) Spontaneous bilateral perirenal haematomas in two patients with eclampsia. J Nephrol 16(4):267–271

    PubMed  Google Scholar 

  59. Gilboa Y, Bardin R, Feldberg D, Bachar GN (2006) Postpartum hepatic rupture and retroperitoneal haematoma associated with HELLP syndrome. JMAJ 8:219–220

    Google Scholar 

  60. Tribble M, Johnston MT (2000) Persistent postpartum bleeding. Proc (Bayl Univ Med Cent) 13(2):183–186

    CAS  Google Scholar 

  61. Ku A, Kern H, Lachman E, Nagler W (1995) Sciatic nerve impingement from piriformis haematoma due to prolonged labour. Muscle Nerve 18(7):789–790

    CAS  PubMed  Google Scholar 

  62. Lev-Gur M, Adachi A, Greston WM, Kleiner GJ (1986) Retroperitoneal haematoma from a ruptured tubl pregnancy as an unusual cause of a pelvic mass: a case report. J Reprod Med 31(4):271–273

    CAS  PubMed  Google Scholar 

  63. Torres GM, Cernigliaro JG, Abbitt PL, Mergo PJ, Hellein VF, Fernandez S, Ros PR (1995) Iliopsoas compartment: normal anatomy and pathologic processes. Radiographics 15:1285–1297

    CAS  PubMed  Google Scholar 

  64. Qanadli SD, El Hajjam M, Mignon F, Bruckert S, Chagnon S, Lacombe P (1999) Life threatening spontaneous psoas haematoma treated by transcatheter arterial embolisation. Eur Radiol 9:1231–1234

    Article  CAS  PubMed  Google Scholar 

  65. Linton EB (1964) Treatment of massive retroperitoneal bleeding associated with late pregnancy, labour and delivery. Obstet Gynecol 24(2):194–197

    CAS  PubMed  Google Scholar 

  66. Jain KA, Olcott EW (1999) Magnetic resonance imaging of postpartum pelvic hematomas: early experience in diagnosis and treatment planning. Mag Reson Imaging 17(7):973–977

    Article  CAS  Google Scholar 

  67. Koh JL, Lee YH, Kang CY, Lin CN (2007) Simultaneous caesarean section and radical nephrectomy for angiomyolipoma with spontaneous bleeding during pregnancy: a case report. J Reprod Med 52(4):338–340

    PubMed  Google Scholar 

  68. Tanaka M, Kyo S, Inoue M, Kojima T (2001) Conservative management and vaginal delivery following ruptured renal angiomyolipoma. Obstet Gynecol 98:932–933

    Article  CAS  PubMed  Google Scholar 

  69. Redzko S, Przepiesc J, Urban J (2003) Retropeitoneal haematoma during pregnancy–diagnostic dilemma. Ginekol Pol 74(6):468–471 Abstract; article in Polish

    PubMed  Google Scholar 

  70. Kent KC, Moscucci M, Mansour KA, DiMattia S, Gallagher S, Kuntz R, Skillma JJ (1994) Retroperitoneal haematoma after cardiac catheterisation: prevalence, risk factors, and optimal management. J Vasc Surg 20:905–910

    CAS  PubMed  Google Scholar 

  71. Morales JP, Georganas M, Khan MS, Dasgupta P, Reidy JF (2005) Embolisation of a bleeding renal angiomyolipoma in pregnancy: case report and review. Cardiovasc Intervent Radiol 28(2):265–268

    Article  PubMed  Google Scholar 

  72. Vegas G, Illescas T, Munoz M, Perez-Pinar A (2006) Selective pelvic arterial embolisation in the management of obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 127(1):68–72

    Article  PubMed  Google Scholar 

  73. O’Hanlan KA, Trambert J, Rodriguez-Rodriguez L, Goldberg GL, Runowicz CD (1989) Arterial embolisation in the management of abdominal and retroperitoneal haemorrhage. Gynecol Oncol 34(2):131–135

    Article  PubMed  Google Scholar 

  74. Feliciano DV (1990) Management of traumatic retroperitoneal haematoma. Annals of Surg 211(2):109–123

    Article  CAS  Google Scholar 

  75. Swift DL, Lingeman JE, Baum WC (1980) Spontaneous retroperitoneal haemorrhage: a diagnostic challenge. J Urol 123(4):577–582

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hereford Hospitals NHS Trust, County Hospital, Union Walk, Hereford, HR1 2ER, UK

    Junaid Rafi

  2. Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 2PW, UK

    Hari Muppala

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  1. Junaid Rafi
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Correspondence to Junaid Rafi.

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Rafi, J., Muppala, H. Retroperitoneal haematomas in obstetrics: literature review. Arch Gynecol Obstet 281, 435–441 (2010). https://doi.org/10.1007/s00404-009-1282-y

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