Postpartum retroperitoneal hematoma secondary to ovarian artery rupture: A case presentation

Postpartum retroperitoneal hematoma (RPH) is a rare but potentially life-threatening complication of vaginal delivery, often presenting with subtle and nonspecific symptoms that delay diagnosis. We describe a case of a 29-year-old multiparous woman who developed severe abdominal pain and cardiovascular compromise 2 days after an uncomplicated vaginal delivery. Initial hemoglobin was 6.6 g/dL with no evidence of external bleeding. Contrast-enhanced computed tomography angiography (CTA) revealed a large 140 mm × 80 mm left-sided RPH associated with the ovarian artery. Emergency laparotomy confirmed ovarian artery rupture, which was surgically ligated, leading to full recovery. This case underscores the importance of maintaining a high index of suspicion for RPH in postpartum patients with unexplained shock, the critical role of prompt CTA imaging, and the necessity of timely surgical intervention in unstable patients. Risk factors, diagnostic pitfalls, and management strategies are discussed, emphasizing the multidisciplinary approach required in emergency settings.