Splenic Artery Rupture during Labor: A Case Report

Abstract

FREQUENCY of a splenic artery rupture has been reported as 6.6% out of 45 patients in whom splanchnic artery aneurysms were encountered, 1 with one study reporting 20% of ruptures occurring during pregnancy. 2 Splenic artery rupture is associated with a high maternal mortality of 75% and fetal wastage of 95%, 3 because of the difficulty in diagnosis and delay in surgical intervention. Of more than 90 cases reported in the literature, in only seven did the mother and fetus survive and only 25 mothers survived (including the present case). [4][5][6] To our knowledge, the patient described here is the only case of splenic artery rupture encountered at the Central Maternity Hospital, where deliveries number approximately 18,000 annually. Case ReportA 35-year-old Saudi woman was admitted to the labor suite from a peripheral hospital because of failure to progress after 12 hours of spontaneous labor and suspected rupture of uterus. Her condition had deteriorated suddenly two hours prior to admission at our hospital. The patient had had five full term spontaneous vaginal deliveries at home. Her sixth delivery had been terminated by cesarean section because of placenta previa three years before the current pregnancy. All her offspring were alive and well. Medical and surgical histories were noncontributory. The current pregnancy had progressed normally without antenatal care until the onset of labor at term. The patient was transferred to the hospital from home, when a few hours after the onset of labor, she became irritable and complained of vague abdominal pain. The patient and her husband denied any history of trauma during pregnancy or labor.On admission to Central Maternity Hospital, the patient looked pale and anxious, had a blood pressure of 90/60 mm Hg, and a weak pulse of 110 beats per minute. The uterus was at term and not tender. The fetus was not easily palpable, and fetal heart beat was inaudible. Vaginal examination showed that the cervix was 4 cm dilated, the forewaters were absent, the presentation was cephalic at -3 station, the liquor scanty, and meconium stained. There was no vaginal bleeding. Her hemoglobin was 7 g/dl, the blood group was O (rhesus positive), and her coagulation profile was within acceptable limits. The clinical picture suggested rupture of the lower segment cesarean section scar which led to intra-abdominal hemorrhage and subsequent intrapartum fetal death. Afer initial resuscitation measures, laparotomy was performed through a lower paramedian incision. The peritoneal cavity contained approximately 3,000 ml of free and clotted blood. The uterus was intact. A normal fresh stillborn female infant weighing 3.1 kg and a fundal placenta were delivered by lower segment cesarean section. There was no evidence of retroplacental hemorrhage. Following upward extension of the incision toward the xiphisternum, further exploration showed blood coming from the splenic vessels near the hilum of a normal-looking spleen. The vessels appeared normal with no visible evidence of an aneurysm. Splenecto...

Rupture of Splenic Artery Aneurysm During Pregnancy: Three Case Reports with a Review of the Literature

“…Analysis of all cases reported in the literature [8,[13][14][15][16][17][18][19][20][21][22][23] brought to light 75 cases of splenic artery ruptures in pregnancy. Although extremely rare, this event is more common in pregnancy.…”

“…Studies have reported that 20% of ruptures occur during pregnancy [10,11,21,24,25]. Based on the incidence of aneurysms in the female population that become symptomatic during the reproductive years, it has been calculated that between 6.6 to 10% will rupture during pregnancy [9,12,13,20,21,22,24]. Of the 75 cases reported, 69.3% ruptured in the third trimester, 8% in the second trimester, 8% during labor, and 14.7% postpartum.…”

“…Stanley and Fry [10] found a 0.78% incidence of splenic artery aneurysm revealed by abdominal aortography examinations. Splenic artery aneurysms are more common in women, and splenic artery aneurysms are encountered more frequently in parous than in nonparous women [5,9,11,12].Analysis of all cases reported in the literature [8,[13][14][15][16][17][18][19][20][21][22][23] brought to light 75 cases of splenic artery ruptures in pregnancy. Although extremely rare, this event is more common in pregnancy.…”