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Obstetrics and Gynecology
Resident PGY 2
Henry Ford Hospital
A 19-year-old G1P0 with insignificant past medical history was admitted at 39w1d gestation for induction of labor after having category 2 fetal heart tones. Her induction was unremarkable aside from bradycardia in the second stage of labor requiring a vacuum-assisted delivery and episiotomy. Immediate postpartum course was complicated by a hemorrhage with a total estimated blood loss of 1450 cc. A CT scan was obtained to rule out retroperitoneal bleeding given her significant blood loss with downtrending hemoglobin. CT showed a wedge-shaped hypoattenuation concerning for multiple renal infarcts vs pyelonephritis. Etiology was suspected to be due to hypoperfusion during episodes of significant hypotension. Postpartum hemorrhage is not a causative event typically associated with acute renal infarction. The most commonly cited risk factors include cardiovascular disease, renovascular injury, and hypercoagulability – none of which were applicable to this patient. Although the patient in our report was without symptoms, renal infarction can present as acute abdominal or flank pain, and sometimes hypertension. There have been rare case reports associating a postpartum hemorrhage with a renal infarction, but given its rarity it is not a complication typically considered by obstetric providers in the setting of a hemorrhage. Evidence such as this may prompt clinicians to have greater suspicion for this sequela of postpartum hemorrhage if a patient suddenly develops the symptoms described above or signs of acute kidney injury without alternative explanation.
Kole, Monica and Keerthy, Madhurima, "Postpartum Hemorrhage Leading to Renal Infarction" (2019). Case Reports. 55.