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  1. Adult giant hydronephrosis diagnosed in the second trimester of pregnancy: A case report and literature review
    Ramly F, Mohamad NAN, Zahid AZM, Kasim NM, Teh KY
    Case Rep Womens Health, 2021 Jan;29:e00275.
    PMID: 33304832 DOI: 10.1016/j.crwh.2020.e00275
    Adult giant hydronephrosis in a normally sited kidney is unusual during pregnancy. The most frequent cause is congenital obstruction at the ureteropelvic junction. Ultrasound accompanied by magnetic resonance imaging (MRI) are valuable in reaching the diagnosis, especially when clinical assessment of an abdominal mass is inconclusive regarding aetiology. We report a case of giant hydronephrosis in a woman who presented at 23 weeks of gestation with abdominal distension. She was managed conservatively. Unfortunately, the pregnancy was complicated by severe pre-eclampsia at 32 weeks of gestation, necessitating delivery via emergency caesarean section. She had a smooth postpartum recovery, and subsequently standard imaging was performed before nephrectomy. The literature and previously reported cases of giant hydronephrosis in pregnancy are reviewed.
  2. Fulltext Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report
    Zon EM, Afendi NR, Ismail MP, Ibrahim A, Che Hashim NAH
    Case Rep Womens Health, 2022 Oct;36:e00463.
    PMID: 36389633 DOI: 10.1016/j.crwh.2022.e00463
    Introduction: A retroperitoneal hematoma in obstetrics is very rare following spontaneous vaginal delivery. It requires a high index of suspicion, especially in a hemodynamically unstable patient with no active bleeding or external trauma postpartum, as early intervention is needed to prevent maternal morbidity and mortality. Conservative management may be an appropriate strategy in managing large hematomas even though surgical evacuation is classically recommended.

    Case: We report the case of a 39-year-old woman, para three, with a hematoma of the Retzius space after spontaneous uncomplicated vaginal delivery. The patient had sudden abdominal pain associated with urinary retention, two hours after delivery. She had a palpable mass at the anterior upper part of the vaginal wall, near the fornices, but no abnormality was detected at the labia majora, labia minora and lower part of the vagina. A transabdominal ultrasound scan revealed a mixed-echogenicity mass between the bladder and lower part of the uterus measuring 110 × 90 × 60 mm. The patient's hemoglobin level dropped from 12 g/dL to 10 g/dL. Given the patient's clinically stable state, she was managed conservatively with antibiotics, analgesics and one unit of packed red blood cells, and was discharged home day 5 postpartum.

    Conclusion: This case supports the conservative management of even large Retzius space hematomas for hemodynamically stable patients. A high index of suspicion and thorough evaluation are required when encountering a complaint of urinary retention and abdominal pain postpartum.

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