Maternal Morbidity and Mortality associated with Retroperitoneal Haematmas in Pregnancy

What is it about?

Retroperitoneal haematomas in obstetrics are uncommon. The causes and pathogenesis of retroperitoneal haematomas lack clarity and the aim of this review is to recognise retroperitoneal haematomas as a separate entity from commonly seen vaginal and pelvic haematomas. It is time to raise awareness among obstetricians to recognise retroperitoneal haematomas as an important cause of maternal morbidity and mortality which requires high clinical suspicion and multidisciplinary input. As retroperitoneal haematomas are rare but can cause serious threat to maternal wellbeing, resources should be directed towards their management. Existing guidelines of maternal collapse and morbidity during pregnancy and puerperium need to include retroperitoneal haematomas as one of the important causes of maternal shock or morbidity. New learning pathways should be opted for to increase awareness of retroperitoneal haematomas among obstetricians enabling them to reflect on their implications while managing retroperitoneal haematomas. Management of retroperitoneal haematomas is complex and continues to improve with advancements in the investigative strategies, treatment options and multidisciplinary involvement

Featured Image

Why is it important?

Retroperitoneal haematomas are a rare entity and different from commonly seen pelvic haematomas thereby demanding more awareness among obstetricians as they can cause maternal collapse and maternal morbidity by posing a serious threat to maternal and foetal wellbeing. Contrary to the usual concept that retroperitoneal haematomas only occur after caesarean section and also that vaginal and Figure 2. Abdominal cavity divided into three zones as a guide while managing retroperitoneal haematomas. Rafi and Khalil 7 instrumental deliveries can only cause vaginal, infralevator and supralevator haematomas, this review highlights that retroperitoneal haematomas can also occur after normal vaginal and instrumental deliveries. Also apart from mechanical causes, we mentioned the pathophysiology of unexpected spontaneous causes of retroperitoneal haematomas in pregnancy, which can be easily missed due to rarity in occurrence. retroperitoneal haematomas can occur during antenatal period, intrapartum and postpartum period. Existing guidelines of maternal collapse and morbidity during pregnancy and puerperium need to include retroperitoneal haematomas as one of the important causes of maternal shock or morbidity. New learning pathways should be opted for to increase awareness of retroperitoneal haematomas among obstetricians enabling them to reflect on its implications while managing retroperitoneal haematomas