Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

International Journal of Emergency Medicine

Case Report

Anh Dinh Bao Vuong¹  Xuan Trang Nguyen¹  Ngoc Bich Trinh¹  Phuc Nhon Nguyen²  Quang Nhat Ho³  Thanh Hai Pham⁴ 

[1] Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam;Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam;Tu Du Clinical Research Unit (TD-CRU), Ho Chi Minh City, Vietnam;Department of Postoperative Care, Block A, Tu Du Hospital, Ho Chi Minh City, Vietnam;Tu Du Clinical Research Unit (TD-CRU), Ho Chi Minh City, Vietnam;

关键词: Emergency;    Hemoglobin;    Maternal mortality;    Pregnancy;    Fetal death;    Spontaneous hemoperitoneum;    Ultrasound;   

DOI  :  10.1186/s12245-023-00498-w

 received in 2022-12-13, accepted in 2023-04-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSpontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively.Case presentationThe pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient’s history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later.ConclusionsIn pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate.

【 授权许可】

CC BY   
© Springer-Verlag GmbH Germany, part of Springer Nature 2023. corrected publication 2023

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