Spontaneous Uterine Vessels Rupture in a Pregnant Woman: A Case Report

AUTHORS

Farideh Farahbakhsh 1 , Mojgan Barati 1 , Farideh Moramezi 1 , * , Zeinab Zamanpoor 1

1 Fertility, Infertility and Perinatology Research Center, Imam Khomeini Hospital, Medicine Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran

How to Cite: Farahbakhsh F, Barati M, Moramezi F, Zamanpoor Z. Spontaneous Uterine Vessels Rupture in a Pregnant Woman: A Case Report, Jentashapir J Cell Mol Biol. 2015 ; 6(4):e28705. doi: 10.17795/jjhr-28705.

ARTICLE INFORMATION

Jentashapir Journal of Health Research: 6 (4); e28705
Published Online: August 29, 2015
Article Type: Case Report
Received: August 21, 2014
Accepted: December 28, 2014
Crossmark

Crossmark

CHEKING

READ FULL TEXT
Abstract

Introduction: Hemorrhagic disease during pregnancy is a major cause of hospital admission and maternal mortality in the world. The most leading causes of maternal hemorrhage during pregnancy are abnormal placentation, ectopic pregnancy, molar pregnancy, and preeclampsia. There are a few case reports of spontaneous rupture of uterine vessels in the literature. The diagnosis of this event, which is hazardous to the pregnant women is difficult due to its rarity.

Case Presentation: Our patient was a 32-year-old primigravid woman presented with abdominal and flank pain. Her gestational age was 30 weeks. During admission in Aria Hospital, she had a significant hemoglobin level drop and developed signs of acute abdomen.

Conclusions: Laparotomy was performed and fundal uterine vessels rupture was seen and ligated. A 30-week-male fetus was born by cesarean section. Now the fetus is alive with no medical problem.

Keywords

Hemorrhage Pregnant Woman Rupture

Copyright © 2015, Ahvaz Jundishapur University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Introduction

Spontaneous uterine vessels rupture is a very rare condition and its etiology is unknown. The diagnosis is very difficult and often it is discovered during laparotomy (1). There are a few case reports in the literature.

Nguessan KL et al. reported a case of spontaneous rupture of uterine varices in the third trimester. There was a rapid onset of maternal collapse with acute fetal distress and only emergency laparotomy allowed for etiological diagnosis and treatment (2).

Andres-Oros et al. reported two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture. In one case, the bleeding ended by compression. In the second one, which was required the vein suture, the diagnosis took place after the fetal death (3).

Berisavac et al. reported a case of spontaneous hematoperitoneoum in the third trimester of twin pregnancy. Because of the deteriorated condition of the patient, it was decided to perform laparotomy, which established the diagnosis of ruptured venous varices on the posterior wall of the uterus. Delivery was performed by cesarean section. The post operative period was uneventful (4).

2. Case Presentation

Our case is a 32-year-old primigravid woman who was admitted on March, 24th, 2014 at 11 pm to the emergency room at Ahvaz Aria Hospital. She was presented with abdominal and flank pain. On the examination, she was found to have a pulse rate of 82 beat/min and a blood pressure of 100/80 mmHg. She was afebrile at 37°C (orally) and FHR was 146/min. Abdominal examination revealed mild uterine contraction. General examination was otherwise unremarkable.

3. Discussion

Investigation on admission revealed hemoglobin of 8.4 g/dL. Ultrasound scan confirmed the presence of a live single fetus with gestational age about 30 weeks and 3 days. She was admitted to the obstetric ward for observation and management of preterm labor. Over the subsequent 3 hours, she had a hemoglobin drop (Hb = 7.9 g/dL) and developed signs of acute abdomen. An urgent surgical consult was requested. The surgical senior register reviewed the patient and with a differential diagnosis of peritonitis (surgical acute abdomen), an urgent laparotomy was arranged. The laparotomy was performed by the gynecologist and general surgeon. She was found to have 2 liters free blood and clot in her pelvis with an active bleeding from superficial vessels on fundus and body of uterus. At first, we determined to control the bleeding, but fragile tissue forced us to perform cesarean section. Then, a male fetus by gestational age of about 30 weeks was born. The placental site was anterior not prevail, and finally the superficial vessels were lighted. Now the infant is 11 months old and is growing well.

To conclude, in every pregnant woman with hemodynamic unstable condition, the possibility of uterine vessels rupture should be kept in mind.

Acknowledgements

References

  • 1.

    Achanna KS, Goh CS. Uterine artery bleeding and haemoperitoneum during the second trimester in pregnancy. Med J Malaysia. 2003; 58(1) : 128 -30 [PubMed]

  • 2.

    Nguessan KL, Mian DB, Aissi GA, Oussou C, Boni S. Spontaneous rupture of uterine varices in third trimester pregnancy: an unexpected cause of hemoperitoneum. A case report and literature review. Clin Exp Obstet Gynecol. 2013; 40(1) : 175 -7 [PubMed]

  • 3.

    Andres-Oros MP, Server-de Castro L, Roy-Ramos V, Vela-Lete A. [Spontaneous uterine venous rupture during pregnancy. Description of two cases and bibliographical review]. Ginecol Obstet Mex. 2010; 78(2) : 128 -31 [PubMed]

  • 4.

    Berisavac M, Sparic R, Pervulov M, Arsenijevic L, Spremovic-Radjenovic S, Vrzic-Petronijevic S, et al. [Spontaneous intra-abdominal bleeding in twin pregnancy--case report]. Srp Arh Celok Lek. 2008; 136(5-6) : 299 -301 [PubMed]

  • COMMENTS

    LEAVE A COMMENT HERE: