Retroperitoneal Hemorrhage: A Rare Cause of Severe Acute Maternal Morbidity and Perinatal Mortality

Retroperitoneal hemorrhage in the form of spontaneous adrenal hemorrhage or bleeding into a renal tumor can have varied and non-specific presentations in pregnancy. In the absence of risk factors, these life-threatening conditions are rarely suspected. We present our experience with three patients who presented to us in the third trimester of pregnancy with hemorrhage in retroperitoneal organs. One of the patients had a spontaneous adrenal hemorrhage and the other two had a hemorrhage in the renal tumor. None of the patients was known to have pre-existing tumors, coagulopathy, or trauma. Both the patients with hemorrhage in the renal tumor had intrauterine fetal demise at the time of presentation. Immediate resuscitation and recruitment of a multidisciplinary team resulted in optimal maternal outcomes in all cases and a healthy fetal outcome in the patient with adrenal hemorrhage.