Retzius space haematoma as a rare cause of concealed retroperitoneal postpartum haemorrhage following spontaneous vaginal delivery

A 34-year-old woman presented to hospital in shock 8 hours after a spontaneous home vaginal delivery. She is a known carrier of haemophilia A. Examination revealed a tender but firm, central and contracted uterus. There was a small second-degree perineal tear which was not actively bleeding and no other trauma or bleeding visualised in the vault or cervix. Bedside ultrasound showed a large 1 L blood clot anterior to the empty uterus. Exploratory laparotomy was performed which revealed a haematoma in the Retzius space with extension beneath the anterior serosa of the bladder, through the left broad ligament and into the retroperitoneal space. Bleeding from the Santorini plexus was controlled with haemostatic sutures, reinforced with FLOSEAL and intra-abdominal packing. A CT angiogram and relook laparotomy the following day confirmed haemostasis and facilitated removal of intra-abdominal packs. This case demonstrates a very rare cause of postpartum retroperitoneal haemorrhage.