Puerperal genital hematomas are uncommon causes of postpartum hemorrhage but can be a cause of serious morbidity and even maternal death. When puerperal genital hematomas are clinically occult despite signifi cant blood loss or found as delayed postpartum hemorrhage, there is a high risk of shock. We report a case with shock accompanied by rupture of progressive retroperitoneal hematoma through left upper vaginal wall on 2nd postpartum day. Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Keywords Copyright © 2011. Korean Society of Obstetrics and GynecologyPostpartum hemorrhage (PPH) is the most signifi cant cause of maternal morbidity and mortality worldwide [1]. PPH is defi ned as an estimated blood loss in excess of 500 mL following a vaginal birth or a blood loss of greater than 1,000 mL following cesarean birth [2]. PPH is classifi ed as primary and secondary. Primary PPH occurs within 24 hours of delivery and secondary PPH after 24 hours and within 6-12 weeks post-partum. Puerperal genital hematomas are uncommon causes of PPH but can be a cause of serious morbidity and even maternal death [3]. The incidence of puerperal genital hematoma ranges from 1/300 to 1/1,400. Puerperal genital hematomas can be classified into vulvar, vulvovaginal, paravaginal, retroperitoneal or supravaginal type according to location [4]. When puerperal genital hematomas are clinically occult despite signifi cant blood loss or are found as delayed postpartum hemorrhage, there is a high risk of shock. A close monitoring and prompt treatment should be required. We report a case with shock accompanied by rupture of progressive retroperitoneal hematoma through left upper vaginal wall on postpartum 2nd day. It was suggested to be originated from injury of left vaginal artery. Case ReportA 33-year-old woman (gravida 2, para 2) presented at emergency room with moderate left perineal pain and left lower quadrant abdominal pain. The patient spontaneously delivered a large baby (4.2 kg) after induction of labor two days ago. Physical examination showed tenderness and rebound tenderness on left lower abdominal area. The uterus was fi rm and the fundus was below umbilicus. The vaginal bleeding or laceration was not found on CASE REPORT Korean J

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