Massive Retroperitoneal Hematoma Following Vaginal Delivery: A Case Report and Review of Literature.

Retroperitoneal hematoma is a rare but potentially life-threatening cause of concealed postpartum hemorrhage. Because bleeding is contained within the retroperitoneum, external blood loss may be absent, and symptoms may be nonspecific, resulting in delayed diagnosis. Rapid recognition and intervention are essential to reduce morbidity and mortality. We report a 21-year-old primigravida who developed severe hypotension and pelvic pain a few hours after an uncomplicated vaginal delivery with a small median episiotomy. Ultrasound revealed a 9 × 9 cm pelvic hematoma. Despite aggressive resuscitation, she required laparotomy, which demonstrated diffuse venous oozing from the retro pubic region without an arterial source. Hemostasis was achieved with combined vaginal and retroperitoneal packing. She required a total of 23 units of packed red blood cells, 18 units of fresh frozen plasma, five units of platelets, and two units of cryoprecipitate. She fully recovered following staged re-exploration and definitive closure. Retroperitoneal hematoma should be suspected in postpartum patients with hemodynamic instability and no external bleeding. A multidisciplinary approach and individualized management, including surgical packing, are critical for successful outcomes.