Objective: To report a case of a 31-year-old woman with renal angiomyolipoma (RAML) who presented with progressive massive haematuria with successive pregnancies.
Clinical presentation: A 28-year-old woman presented with mild haematuria in the third trimester of her second pregnancy. This was due to bleeding from a left RAML. Patient became pregnant for a third time. The RAML increased in size and patient bled more during the third trimester. After delivery she refused partial nephrectomy or renal embolisation. In the third trimester of the fourth pregnancy, she presented with massive haematuria, shock, severe anaemia (haemoglobin of 6gm/l) and required a total of 26 units of blood transfusion during a 4-week period. She required emergency Caesarian section at 36 weeks and simple nephrectomy 3 months postpartum.
Conclusion: The risk of profuse haemorrhage from RAML may increase with successive pregnancies in women with RAML. This anomaly should be treated in between pregnancies by either angioembolisation or resectional surgery.