Fatal Retroperitoneal Hemorrhage in Pregnancy due to Screw-Related Vascular Injury After Kyphoscoliosis Surgery

This case report presents a fatal maternal complication that occurred three years after kyphoscoliosis surgery in a 27-year-old primigravida.At 33 weeks of her first pregnancy, the patient developed a massive retroperitoneal hemorrhage secondary to spontaneous vascular injury caused by protruding pedicle screws from prior posterior spinal instrumentation.The increased intraabdominal pressure and progressive uterine expansion during advanced pregnancy are thought to have exacerbated contact between the screw tips and the iliac vessels, eventually extending to the abdominal aorta.This catastrophic vascular injury precipitated a large retroperitoneal hematoma and subsequently triggered placental abruption, culminating in maternal mortality despite emergency surgical intervention.To the best of our knowledge, this represents a rare but critical obstetric complication in women with a history of complex spinal instrumentation.The case emphasizes the need for careful multidisciplinary prenatal surveillance, pre-delivery imaging of vascular and implant relationships, avoidance of excessive uterine pressure during delivery, and heightened awareness of screw-related vascular risks during pregnancy and cesarean planning.