Hemoperitoneum during Pregnancy: A Rare Case of Spontaneous Rupture of the Uterine Artery

Silva, Catarina Marçal da; Luz, Rita; Almeida, M. C.; Pedro, Daniel; Paredes, Bárbara; BRANCO, RAFAEL SANTOS; Pereira, Ana Marques

doi:10.1155/2020/8882016

Cited by 11 publications

(28 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding diagnosis, an initial confirmation of abruptio placenta or ruptured uterus should be excluded in the late term pregnancy with acute abdominal pain. Moreover, the differential diagnosis of a suddenly abdominal pain with hemodynamic collapse and no external bleeding included uterine rupture, sepsis, aortic dissection, and venous thromboembolism in pregnant women [ 14 ]. Accordingly, diagnosis of SHiP is more accessible with the presence of free fluid collection on ultrasound considering as the first line in detection.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Vuong

Pham²,

Nguyen

et al. 2023

Int J Emerg Med

View full text Add to dashboard Cite

Background Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively. Case presentation The pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient’s history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later. Conclusions In pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate.

show abstract

Section: Discussionmentioning

confidence: 99%

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Vuong

Pham²,

Nguyen

et al. 2023

Int J Emerg Med

View full text Add to dashboard Cite

show abstract

“…Important differential diagnoses of uterine rupture include abruption of placenta, placenta previa, inversion of the uterus, tear of the cervix or vagina, coagulopathy, atonic uterus, and rupture of the uterine artery [8][9][10]. During pregnancy, clinical features of hemoperitoneum can mimic abruption of the placenta, and endometriosis can lead to erosion of blood vessels leading to severe hemorrhage [11].…”

Section: Discussionmentioning

confidence: 99%

Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital

Tayade¹,

Chadha²,

Khandelwal³

et al. 2022

Cureus

View full text Add to dashboard Cite

Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt's ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality.

show abstract

“…4 It can occur antepartum,intrapartum and postpartum. 5,6 Although, most commonly seen in 3 rd trimester, either in labor or in postpartum period(within 42 days). The diagnosis is often made retrospectively after laparotomy.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Maternal mortality in these cases can be reduced by improving resuscitative measure and operative techniques. 5 Although,perinatal mortality remains high.…”

Section: Introductionmentioning

confidence: 99%

The case series of spontaneous hemoperitoneum in third trimester pregnancy

Gupta

2022

Asian J Med Sci

View full text Add to dashboard Cite

Spontaneous hemoperitoneum in pregnancy (SHiP) is unprovoked intraperitonealbleeding. It is a rare entity but a life-threatening complication as it is associated with adverse pregnancy outcome. It is a surgical emergency and requireslaparotomy to identify the cause. Complication of pregnancy and spontaneous hemoperitoneum wasincluded in the study, and cases involving pregnancy termination and ectopic pregnancy were excluded from the study.Maternal demographics, description of spontaneous hemoperitoneum, and specifics diagnosis and management were recorded. Data were extracted and entered in reporting forms. Median values were calculated for continuous variables, and percentages were calculated for categorical variables. The authors reported three cases of SHiP were seen. The gestational age of the patient included in the studywas36 weeks, 38 weeks, and 34+6 weeks, respectively. In the first 2 cases, clinical picture was pointing toward maternal hypovolemia while in 1st case ultrasound s/o fetal demise and in the 2nd case, there was fetal distress. In the 3rd mentioned case, fetal distress was observed on the examination, and hemoperitoneum was the incidental finding which was due to endometriosis.The cause of SHiPis rupture of posterior wall of the uterus, rupture of utero-ovarian vessels, and endometriosis.

show abstract

Hemoperitoneum during Pregnancy: A Rare Case of Spontaneous Rupture of the Uterine Artery

Cited by 11 publications

References 5 publications

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Uterine Rupture Following Non-Operative Vaginal Delivery: A Close Save of Delayed Presentation With Hemoperitoneum to a Rural Tertiary Care Hospital

The case series of spontaneous hemoperitoneum in third trimester pregnancy

Contact Info

Product

Resources

About