Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy

Ruptura espontânea de artéria uterina por foco de endometriose: relato de caso

“…Durante o primeiro trimestre, a endometriose está associada com um risco aumentado de perda fetal causada por gravidez ectópica e aborto espontâneo. Enquanto que no terceiro trimestre gestacional, pode ocorrer uma complicação rara, mas com consequências muitas vezes fatais, o hemoperitônio espontâneo, correspondendo a 120 casos relatados até 1980 (7)(8)(9) . Essa patologia é o principal fator de risco para o hemoperitônio espontâneo durante a gestação.…”

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

“…They thought that chronic inflammation due to endometriosis may render utero-ovarian vessels more friable, or the resultant adhesion may give further tension to these vessels when the uterus is enlarged during pregnancy. Endometriosis seems to be a major risk factor of SH in pregnancy [2,5,12,14]. Brosens et al [2] in their series noted that 52% of all patients suffering from SH during pregnancy reported in the last 20 years suffered from known or unknown endometriosis.…”

“…In other cases, active bleeding is described from endometriosic lesions with or without tears [4,13,14]. Inoue et al suggested that endometriosis may be involved in the rupture of these vessels [5].…”

“…Brosens et al [2] in their series noted that 52% of all patients suffering from SH during pregnancy reported in the last 20 years suffered from known or unknown endometriosis. Reviewing the literature, we can differentiate various major etiologies of spontaneous hemorrhage in endometriosis during pregnancy, which are explained by physiopathology: utero-ovarian vessel ruptures and bleeding endometriosis implants [14]. An alternative explanation supposed by Brosens et al [2] may be the involution of decidualizing ectopic endometrium during pregnancy secondary to the fall of progesterone during the post-partum period [12,15,16].…”

Idiopathic spontaneous haemoperitoneum in pregnancy

“…Published series report maternal mortality ranging from 3.6%-49%. 5 Maternal mortality associated with SHiP dropped dramatically throughout the years to approximately 4%. 3,[6][7][8] Foetal mortality on the other hand remains high involving more than 1/3 rd of all cases with most deaths attributable to maternal shock.…”