Hemorrhage from Ruptured Uteroovarian Veins During Pregnancy

Spontaneous Hemoperitoneum in the Immediate Post-Partum Caused by Endometriosis and Labour

“…It is defined as an unprovoked intraperitoneal bleeding that may be idiopathic or related to many causes such as uterine rupture, placental abruption, spontaneous ruptures of uterine varicosities, placenta percreta, liver or splenic rupture in preeclampsia, trauma, ectopic pregnancy and other rare causes such as a spontaneous rupture of a splenic artery aneurysm, or a ruptured appendix. The most common cause of SH is spontaneous utero-ovarian vessel rupture in pregnancy [1][2][3][4][5][6][7][8][9][10][11][12]. SH in pregnancy occurred before labour for 61%, intrapartum for 18% and puerperal for 21%.…”

“…It has been reported to occur during pregnancy, labour, and the early postpartum period. Though advances in anaesthetic, resuscitative, and operative techniques have played a role in lowering the maternal mortality rate from 49% in 1950 to 3.6% in 1987, the perinatal mortality rate in women with SH remains high at 36% [1,2,3]. Prompt diagnosis and intervention are critical for improving outcomes in these patients.…”

Endometriosis is a possible risk factor for spontaneous hemoperitoneum in the third trimester of pregnancy

“…The cause of the spontaneous rupture remains unclear. Hodgkinson and Christensen (2) have suggested that sudden increases in venous pressure in the utero-ovarian circulation associated with muscular activity and straining can cause rupture. However, in healthy pregnant women, extensive physiologic hypertrophy of uterine vessels deals effectively with pressure fluctuations (3), and it is probable that some additional vascular defect may be present (1).…”

“…Sixty-one percent of ruptures were diagnosed before the onset of labor, 18% during labor, and 21% presented in the postpartum period. It appears to be more severe if it occurs during labor, presumably because of the confounding influence of painful uterine contractions (2). A high maternal mortality (49.3%) (2) was expected before the improvement of intensive care; it decreased to 4% between 1950 and 1985 (1).…”

“…A vascular defect contributing to the weakness of the physiologically hypertrophied uterine vessels has been suggested (1). Inoue et al (6) have suggested at least two possible explanations for the involvement of endometriosis: [1] chronic inflammation due to endometriosis may make utero-ovarian vessels more friable; [2] the resultant adhesions may give further tension to these vessels when the uterus is enlarged during pregnancy. Both of our patients had moderate to severe endometriosis and had undergone surgical interventions that included lysis of adhesions.…”