Vaginal bleeding may be present in up to 30% of patients presenting with signs and symptoms of a rupture of the fetal membranes (ROM). The presence of blood may lead to false positive results with biochemical markers. The data presented in this study came from a multi-centric prospective observational clinical study that, for the first time, systematically evaluated the performance of placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (IGFBP-1) detecting tests in 151 women with vaginal bleedings as well as signs and symptoms indicative of ROM. Our data showed better performance for the PAMG-1 compared with the IGFBP-1 detecting tests in all quality parameters evaluated. In detail, sensitivity (SN) was 97.8% (91.0%), specificity (SP) was 91.5% (75.0%), positive predictive value (PPV) was 94.6% (83.5%) and negative predictive value (NPV) was 96.4% (85.7%) for PAMG-1 tests (and IGFBP-1 tests, respectively). A major difference between both tests was related to the number of non-evaluable test results (e.g., hidden bands due to blood smear on the test strips). While 2% of all results were not evaluable for PAMG-1 tests, this artifact appeared in 11% of the results obtained with IGFBP-1 tests. This difference and also those in Specificity and PPV were statistically significant, demonstrating superiority of PAMG-1 over IGFBP-1 detecting tests. In conclusion, the PAMG-1 detecting test was significantly less susceptible to interference by blood than the IGFBP-1 detecting test.

Einleitung: Intraabdominelle Blutungen im 2. und 3. Trimenon sind eine absolute Rarität. Hierfür sind keine typischen Diagnosen bekannt, so dass trotz absoluten klinischen Handlungszwangs eine interdisziplinäre Abstimmung erfolgen sollte (chirurgische Ursachen, Aneurysmablutung?). Kasuistik: Wir berichten über eine 30-jährige II. Gravida, I. Para, die in der 26. SSW unter absoluten Ruhebedingungen perakut durch eine intraabdominelle Blutung verbunden mit der adäquaten schweren Schocksymptomatik auffiel. Eine geburtshilfliche Ursache dieses Geschehens ließ sich weitest gehend ausschließen. Unabhängig vom Schwangerschaftszeitpunkt musste nach klinischen Richtlinien die sofortige Laparotomie zur Lebensrettung der Mutter erfolgen. Die Beendigung der Schwangerschaft in der 26. + 1 SSW durch simultane Sectio caesarea (Korpuslängs-schnitt) war zwingend notwendig. Als Ursache der Blutung fand sich eine arrodierte A. ovarica sinistra im Rahmen einer fortgeschrittenen Endometriose, die offenbar dezidual umgewandelt war. Nach Umstechungen und Adnexektomie links stand die Blutung. Mutter und Kind haben gesund überlebt. Schlussfolgerungen: Auch in der Schwangerschaft ist grundsätzlich bei der klassischen Notfallsituation "akutes Abdomen" verbunden mit einer schweren Schocksymptomatik nach allgemein gültigen klinischen Richtlinien zu verfahren. Jede Verzögerung der therapeutischen Intervention kann direkt letale Folgen für Mutter und Kind AbstractIntra-abdominal bleeding in the 2nd and 3rd trimester is an absolute rarity and in many cases its diagnosis is not straightforward. Therefore multidisciplinary care plays an important role (surgical causes such as ruptured aneurysm). Case Report: We are reporting on a 30-year-old patient in her second pregnancy at 26 weeks gestation. She presented acutely with severe shock because of intra-abdominal bleeding for which there was no recognizable obstetric reason. Regardless of the duration of pregnancy, life-saving laparotomy had to be carried out. The termination of pregnancy at 26 weeks gestation by caesarean section (longitudinal upper segment caesarean section) was unavoidable. The reason for bleeding was a ruptured ovarian artery because of advanced decidualised endometriosis. Control of bleeding was achieved through left adenexectomy and ligation of the left ovarian artery. The mother and the baby survived and are well. Conclusion: In pregnancy too, one should react without delay in cases of acute abdomen associated with shock. Any delay can cost the life of mother or baby. In the case of a life-threatening condition of the mother the condition of the baby is second to her. It is necessary that the parents are informed that in the majority of cases the termination of pregnancy is necessary.