Massive postpartum right renal hemorrhage.
All reported cases of massive postpartum right renal hemorrhage have involved healthy young primigravidas and blacks have predominated (4 of 7 women). Coagulopathies and underlying renal disease have been absent. Hematuria was painless in 5 of 8 cases. Hemorrhage began within 24 hours in 1 case, within 48 hours in 4 cases and 4 days post partum in 3 cases. Our first case is the only report in which hemorrhage has occurred in a primipara. Failure of closure or reopening of pyelovenous channels is suggested as the pathogenesis. The hemorrhage has been self-limiting, requiring no more than 1,500 cc whole blood replacement. Bleeding should stop spontaneously, and rapid renal pelvic clot lysis should follow with maintenance of adequate urine output and Foley catheter bladder decompression. To date surgical intervention has not been necessary.
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D003558:Cystoscopy; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007668:Kidney / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000150:complications*; D007682:Kidney Pelvis / Q000098:blood supply / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011859:Radiography; D014513:Ureter / Q000033:anatomy & histology / Q000378:metabolism; D014517:Ureteral Obstruction / Q000473:pathology; D014546:Urinary Catheterization; D014680:Veins; D014690:Venous Pressure