Hématome rétropéritonéal géant péripartum d’un accouchement normal, « expectative attitude »

Large retroperitoneal hematoma following vaginal delivery: a case report

“…Pregnancy-associated retroperitoneal hematoma is distinguished by its timing of onset, which can occur during pregnancy or up to 4 weeks postpartum. Onset can be acute or subacute [ 1 , 4 , 5 ] and may result from rupture of an arterial aneurysm, or injury due to obstetric trauma to the pelvic venous plexus, which is dilated and fragile during pregnancy [ 4 , 5 ]. Several risk factors for retroperitoneal hematoma have been identified: coagulation disorders, congenital Ehlers-Danlos syndrome type 4 with rupture of retroperitoneal vessels, prior use of anticoagulant treatment, severe preeclampsia, HELLP [hemolysis, elevated liver enzymes, low platelet count] syndrome, multiparity, macrosomia, multiple pregnancy, prolonged active phase of labor, traumatic delivery, and manual delivery of the placenta [ 1 , 2 , 6 ].…”

“…Retroperitoneal hematoma is a rare and potentially life-threatening complication of pregnancy and childbirth, characterized by acute or subacute bleeding from the abdominal tissues into the retroperitoneum [ 1 , 2 ]. The lack of specific signs and symptoms associated with retroperitoneal hematoma complicates its diagnosis, and if the condition is not treated promptly, it may endanger the patient's life [ 1 , 3 , 4 ]. However, retroperitoneal hematoma is poorly documented in the literature [ 1 , 2 , 4 ], particularly in low-income countries, where risk factors for this condition may be more prevalent and the prognosis poorer.…”

“…The lack of specific signs and symptoms associated with retroperitoneal hematoma complicates its diagnosis, and if the condition is not treated promptly, it may endanger the patient's life [ 1 , 3 , 4 ]. However, retroperitoneal hematoma is poorly documented in the literature [ 1 , 2 , 4 ], particularly in low-income countries, where risk factors for this condition may be more prevalent and the prognosis poorer. We present a case of retroperitoneal hematoma that developed progressively during the 14 days following an uncomplicated and nontraumatic vaginal delivery in a resource-limited setting.…”

Maternal morbidity and mortality associated with retroperitoneal haematomas in pregnancy

“…. Femoral neuropathy, 16 spasms of iliopsoas muscle and sciatica are seen with retroperitoneal haematomas in the iliopsoas region. .…”

“…Often the clinical picture is sudden in onset and other common features are abdominal pain, accompanied by signs of hypovolemic shock and reduction in haematocrit. Vomiting, diarrhoea and epigastric pain may be initial symptoms in splenic artery rupture. In gradually developing retroperitoneal haematoma, the early diagnosis is difficult to establish. It manifests only after a significant amount of blood loss has occurred with resultant haemodynamic compromise. Vaginal and rectal pain with oedematous vaginal mucosa protruding through introitus may be seen in lower pelvic haematomas. Femoral neuropathy, 16 spasms of iliopsoas muscle and sciatica are seen with retroperitoneal haematomas in the iliopsoas region. It has been reported that in some cases where retroperitoneal haematoma extend from pararenal space to pelvis, the patient cannot perform hip flexion and knee extension. 8 Cullen’s sign, which is bruising around umbilicus, occurs due to tracking of haemorrhagic fluid from the retro-peritoneum along the gastrohepatic and falciform ligament to the umbilicus. Grey Turner’s sign is the blackish discolouration of flanks which may be seen in some cases 24–48 h after the retroperitoneal haematomas development.…”