Renal hematoma: An unusual cause of acute abdomen and fetal demise in severe Pre-Eclampsia.

Retroperitoneal hematoma occurs rarely in an obstetric patient. Renal hematoma may present with signs and symptoms, which may mimic the clinical presentation of abruptio placentae or rupture uterus. Although renal hematoma is sometimes a surgical emergency due to hypovolemic shock, conservative management by angiographic embolization may be done. Timely diagnosis and management is required to decrease the maternal mortality and morbidity. We hereby report a case of spontaneous renal hematoma in a patient with severe pre-eclampsia who presented with acute abdomen and intrauterine fetal death.

The impact of primary postpartum hemorrhage in "near-miss" morbidity and mortality in a tertiary care hospital in North India.

AIM: To assess risk factors, mortality and "near-miss" morbidity in early PPH. SETTING AND DESIGN: Retrospective analysis of 178 women with early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North India. MATERIALS AND METHODS: All case sheets of patients identified by labor record registers as having early PPH were reviewed by the same person to identify the actual impact of condition. The data was analyzed by chi-square analysis. RESULT: Early PPH (loss of blood that caused significant alteration in maternal condition or blood loss 500 in vaginal deliveries or> 1000 cc in cesarean section) was recorded in 178; 90 delivered in hospital (Group-A) and 88 referred after delivery (Group-B) from various peripheral centers, i.e., maternity hospitals, nursing homes, district and community health centers. The maternal mortality ratio during this period was 1049/100,000 (139 deaths/13248 live births; direct maternal deaths = 94). Early PPH accounted for 11/94 direct maternal deaths (11.7%). Of these 11 deaths, 3 were in group A and 8 in group B. "Near-miss" morbidity was higher than mortality (Total 19/178; 5/90 in Group-A and 14/88 in Group-B). Delayed referral and lack of active 3rd stage management in Group-B were responsible for most of the adverse events. CONCLUSION: Both "near-miss" morbidity and mortality in early PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.