Puerperal hematoma combined with retroperitoneal dissection and obstructive uropathy

Following an otherwise complicated vaginal delivery, puerperal hematomas extending into the retroperitoneum and accompanying obstructive uropathy require surgical intervention. Immediately following vaginal delivery, a 24-year-old woman (G2P2) developed a postpartum hemorrhage (PPH) with formation of a right puerperal vulvovaginal hematoma. Bilateral flank pain occurred as the bleeding continued. A large retroperitoneal hematoma with obstructive uropathy developed, accompanied by hemodynamic instability. Ligation of the hypogastric artery and decompression of the ureters bilaterally was performed, with dramatic relief of the symptoms. Such puerperal hematomas associated with concealed bleeding into the retroperitoneal cavity and ureteral compression require surgical intervention. They should be managed with caution, given their potential progression into the retroperitoneal cavity with excruciating pain, ureteral compression and massive accumulation of blood. Hypogastric artery ligation and early evacuation of blood clots by laparotomy is the treatment of choice.