Spontaneous retroperitoneal bleed 24 hours postpartum: a case report

Abstract

A 27-year-old Hispanic woman (G5 P4 004) presented to the labor and delivery unit at 38 weeks' and 6 days' gestation with onset of active labor. Approximately 24 hours postpartum, the patient had sudden onset of lightheadedness, hypotension, and labored breathing. After evaluation of the patient, including emergency exploratory laparotomy, it was found she had a massive retroperitoneal bleed secondary to spontaneous rupture of the uterine artery as well as rupture of multiple left adnexal veins. A MEDLINE search using the Keywords “postpartum” and “arterial rupture” yielded only 68 citations, 13 of which were specific for spontaneous rupture of a vessel. This is a rare complication of normal vaginal delivery that should be considered in the differential of any woman who has acute onset of hypotension 24 to 48 hours postpartum. Labor and delivery units as well as postpartum recovery units should be equipped to handle such rare but potentially fatal emergencies. This case report describes one such case at a community hospital and describes the outcomes of the case as well as recommendations to handle such emergencies.