Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam

Vuong, Anh Dinh Bao; Nguyen, Xuan Trang; Nguyen, Phuc Nhon

doi:10.1016/j.ijscr.2022.107603

Cited by 6 publications

(11 citation statements)

References 13 publications

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“…Yang et al reported four cases of SHiP, including spontaneous rupture of the uterine veins, spontaneous rupture of the liver, rupture of the external iliac vessel branch, and rupture of the right renal hamartoma [ 1 ]. Meanwhile, Vuong et al revealed the unscarred uterine rupture due to placenta accreta spectrum led to severe SHiP [ 2 ]. Xu et al also described 3 cases of intraabdominal bleeding with the different causes [ 3 ].…”

Section: Introductionmentioning

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

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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.

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Section: Introductionmentioning

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

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Section: Differential Diagnosismentioning

confidence: 99%

“…Imaging in patients with intraperitoneal blood may reveal spontaneous rupture of structures like uterine veins, liver, external iliac vessels, renal hamartoma, uterus, ovarian artery, hepatic or splenic blood vessels or a pedunculated uterine leiomyoma 1 5. Subacute abdominal or flank pain, free peritoneal fluid, Kehr’s sign and decreasing haemoglobin levels are common features in SHiP 1–3. When a pregnant patient presents with acute abdominal pain, especially in the late second or third trimester, consideration should be given to SHiP, particularly if free fluid is noted on imaging along with decreasing haemoglobin 2 9…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Perinatal mortality rates range from 26.9% to 36%. Diagnosing SHiP is complicated by physiological changes in pregnancy, and concerns about radiation exposure often lead to hesitation in performing imaging studies 1–6…”

Section: Introductionmentioning

confidence: 99%

“…Adhesive disease resulting from endometriosis, combined with substantial uterine growth in the second trimester, increases tension on adhesions, possibly causing the rupture of aberrant vasculature. This tension is thought to be a consequence of the rapid expansion of the uterus, frequently affecting the posterior uterine surfaces and parametrium, with bleeding sites predominantly in the left pelvis (75%) 1–6…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous haemoperitoneum in the second trimester of pregnancy

Carlson,

Montoya

2024

BMJ Case Rep

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This is a case of a spontaneous haemoperitoneum occurring in the second trimester of pregnancy which was managed with interventional radiology to avoid laparotomy and its potential consequences. We aim to raise awareness of this condition in pregnancy because the perinatal mortality rate is as high as 36%. Spontaneous haemoperitoneum in pregnancy (SHiP) has frequently been associated with vascular rupture from pre-existing endometriosis. Most cases of SHiP have been managed with laparotomy. However, transcatheter embolisation can impart lifesaving alternatives to more invasive interventions when caring for pregnant patients. More judicious use of imaging procedures may also help improve diagnostic and therapeutic pathways with SHiP. We recommend that high-risk pregnancies are managed in level IV regional perinatal healthcare centres, when possible, where subspecialists and alternative measures of management exist.

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Unscarred uterine rupture with catastrophic hemorrhage immediately after vaginal delivery: diagnosis and management of six consecutive cases

Liao,

Tsang,

Yang

et al. 2023

The Journal of Maternal-Fetal & Neonatal Medicine

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Placenta accreta spectrum on an unscarred uterus in the third-trimester pregnancy: two rare cases at Tu Du Hospital in Vietnam

Cited by 6 publications

References 13 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

Spontaneous haemoperitoneum in the second trimester of pregnancy

Unscarred uterine rupture with catastrophic hemorrhage immediately after vaginal delivery: diagnosis and management of six consecutive cases

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