A 37-year-old pregnant woman, para 3, was transferred to our hospital at 30 weeks of gestational age with severe acute abdomen. Ultrasonography of the abdomen confirmed that body fluid around the uterus was retained. Paracentesis was performed and she was diagnosed with hemoperitoneum. Exploratory laparotomy was performed and arterial bleeding from the posterior of left round ligament was found. Spontaneous rupture of uterine vessel in pregnancy is associated with a high rate of mortality. Unfortunately, clinical symptoms of hemoperitoneum are non-specific. For the well-being of the mother and fetus, rapid diagnosis and surgical treatment of hemoperitoneum during pregnancy is needed. Non-invasive and easy-to-implement ultrasonography can be performed periodically to help diagnose quickly.

Introduction Sonography and magnetic resonance imaging (MRI) may be helpful to obtain an accurate diagnosis of acute abdominal pain in pregnancy. Adnexal torsion presenting in the first or second trimester can be confirmed and treated through laparoscopic surgery; however laparoscopic surgery in the third trimester can be difficult owing to the large uterus, and a gridiron incision can be useful. Case Report/Case presentation An 18-year-old gravida 1, para 0 (G1P0) woman at 30 + 4 weeks of gestation presented with sudden-onset cyclic pain in the right lower quadrant. Abdominal ultrasonography showed a normal appendix, and MRI showed a normal appendix and normal ovaries. The patient’s prominent tender point was marked and compared with the MR images, which confirmed the mark as the position of the right ovary. Laparotomy was performed through a gridiron incision, and a folded right ovary was identified. The ovary was unfolded, and TachoSil® and Surgicel® were used to maintain the unfolded position. The patient’s pain resolved, and her postoperative course was uneventful. She delivered a healthy, 2540-g male baby at 35 weeks’ gestation. Discussion/Conclusions A gridiron incision was useful to treat a folded ovary in the third trimester and to evaluate the adnexa and minimize uterine manipulation.

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