The rupture of the uterine artery leading to hemoperitoneum during pregnancy is an uncommon yet potentially life-threatening occurrence associated with elevated risks for both maternal and perinatal health. Here, we present the case of a 29-year-old woman in her 36th week of gestation who experienced acute abdominal pain due to hemoperitoneum. Diagnostic ultrasound revealed the presence of free fluid in the abdominal cavity, prompting exploratory laparotomy and cesarean section. During surgery, significant blood clots and a bleeding left uterine artery were discovered, underscoring the importance of recognizing this rare etiology of hemoperitoneum during pregnancy.
Introduction:
Spontaneous rupture of uterine vasculature leading to hemoperitoneum is an infrequent but critical complication encountered during pregnancy, often associated with considerable maternal and fetal mortality rates. Clinical manifestations range from subtle symptoms to sudden and severe abdominal pain accompanied by hemodynamic instability. Most reported cases occur during the third trimester of pregnancy, and prompt diagnosis is crucial, particularly in pregnant patients presenting with acute abdominal pain and hemodynamic instability.
Case Presentation:
A 29-year-old nulliparous woman at 36 weeks of gestation presented to the emergency department with severe acute abdominal pain persisting for one hour. Physical examination revealed mild hypotension and intense abdominal tenderness without vaginal bleeding. Ultrasound examination detected significant free fluid in the abdominal cavity, prompting the medical team to proceed with exploratory laparotomy. During surgery, extensive blood clots and a bleeding left uterine artery were identified, necessitating prompt intervention to achieve hemostasis and deliver the baby. Postoperative evaluation revealed a stable decrease in hemoglobin levels, highlighting the successful management of this rare pregnancy complication.
Conclusion:
The case presented underscores the importance of considering spontaneous rupture of the uterine artery as a potential cause of hemoperitoneum during pregnancy, particularly in patients presenting with acute abdominal pain and hemodynamic instability. Timely recognition and appropriate intervention are essential in mitigating the associated maternal and perinatal risks.
