Spontaneous Uterine Vessel Rupture During Pregnancy or in the Puerperium: A Review of the Literature

Abstract

Importance: Spontaneous perinatal rupture of a uterine vessel is a rare occurrence that may lead to severe hemorrhage and requires prompt identification and management.Objective: The aim of this study was to examine the etiologies, locations, diagnostic tools, treatment options, and risks in subsequent pregnancies when spontaneous rupture of a uterine vessel occurs in pregnancy.Evidence Acquisition: A literature search was performed by university research librarians using the PubMed, CINAHL, and Web of Science search engines. Identified were 78 cases of perinatal spontaneous uterine vessel rupture and formed the basis for this review.Results: Increased uterine blood flow during pregnancy may alter the integrity of pelvic vessels leading to increased risk of spontaneous rupture. The uterine artery is the most common site of vessel rupture; the second most common site is the uterine-ovarian plexus. The most common presentation is abdominal or pelvic pain, maternal vital sign abnormalities, and an absence of vaginal bleeding. Exploratory laparotomy and embolization (interventional radiology) have been reported as management options.Conclusions: Spontaneous rupture of uterine vessels is a rare but potentially life-threatening complication of pregnancy that should be included in the differential diagnosis of pregnant patients presenting with an acute abdomen.Relevance: Our aim is to increase the awareness of spontaneous vessel rupture during pregnancy to improve detection, management, and perinatal outcomes.Target Audience: Obstetrician-gynecologists, radiologists, family medicine physicians Learning Objectives: After completing this CME activity, participants should be better able to describe spontaneous uterine vessel rupture; identify its risk factors and presenting symptoms; and explain preferred diagnostic imaging modalities, management options, and possible complications in future pregnancies.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

Spontaneous Rupture of Uterine Vessels in the Third Trimester of Pregnancy Resulting in Severe Hemoperitoneum and Fetal Death: A Case Report and Literature Review

“…Imaging, including abdominal ultrasound and contrast CT scan with contrast, is extremely important for detecting free fluid in the abdomen and ruling out potential causes, including uterine rupture, solid abdominal organ rupture, perforated viscous, and appendicitis. [2][3][4]12 However, owing to the vague patient presentations and rare occurrences, a high index of suspicion is particularly important for diagnosis.…”

Revisión de los protocolos sobre abdomen agudo quirúrgico no obstétrico en el embarazo.

“…Los síntomas incluyen dolor intenso tipo cólico en el costado, náuseas y vómitos en ausencia de signos peritoneales (50). El útero grávido puede dificultar la visualización adecuada de los uréteres durante la ecografía debido a las características del embarazo, la eliminación espontánea de los cálculos renales y ureterales ocurre en el 85% de los casos (51).…”

“…La hemorragia en la cavidad peritoneal durante el embarazo suele asociarse frecuentemente a la ruptura del aneurisma de la arteria esplénica y la ruptura de las venas dilatadas de alta presión del ovario y los ligamentos anchos en el momento del parto. La cual puede iniciar con dolor abdominal intenso localizado o difuso de inicio súbito y progresar rápidamente a shock hipovolémico (51). Se ha estimado que la mortalidad después de la ruptura es del 25% en adultos no embarazadas y aumenta drásticamente al 75% en mujeres embarazadas y se asocia con una mortalidad fetal del 95%, esta suele ser más frecuente en el tercer trimestre de embarazo.…”

“…Se ha estimado que la mortalidad después de la ruptura es del 25% en adultos no embarazadas y aumenta drásticamente al 75% en mujeres embarazadas y se asocia con una mortalidad fetal del 95%, esta suele ser más frecuente en el tercer trimestre de embarazo. El tratamiento recomendado es el uso de la angio embolización, cuya tasa de éxito es mayor al 85% (51). La mediana de edad fue de 29,5 años.…”

Uterine leiomyomas embolization with magnetic resonance imaging follow up

“…The most common cause of gynecological causes of uterine bleeding is myoma (Mercier et al, 2022). Hysterectomy and myomectomy have performed for long time in the treatment of different causes of uterine bleeding over the last century; however, they are associated with significant morbidity (Giuliani, As-Sanie, & Marsh, 2020).…”