Massive obstetric hemorrhage caused by spontaneous rupture of uterine blood vessels
Tskhay V.B., Domracheva M.Ya., Brekhova I.S., Raspopin Yu.S.
Spontaneous rupture of uterine veins and arteries is a rare and life-threatening cause of hemoperitoneum during pregnancy, labor, and the postpartum period. The differential diagnosis should exclude rupture of uterine, adrenal, splenic, renal, or hepatic veins, ruptured aneurysm or pseudoaneurysm, presence of arteriovenous malformation, as well as endometriosis or iatrogenic lesions.
Case report: A primigravida with a relevant surgical history (operated for retrocervical endometriosis and endometrioid cysts) at 35 weeks’ gestation (dichorionic, diamniotic twins) was admitted to the Krasnoyarsk Regional Clinical Center for Maternal and Child Health with complaints of intense pain in the abdomen and right subcostal area. An urgent cesarean section was performed due to suspected intra-abdominal hemorrhage. In order to identify the source of intra-abdominal bleeding, exploration of the abdominal cavity and pelvic organs was performed together with the abdominal surgeon involved in the operation. The abdominal exploration revealed that the source of intra-abdominal bleeding was a rupture of uterine superficial varicose veins which were localized in the right lower third of the posterior wall of the uterus. Reliable surgical hemostasis was achieved by suturing the bleeding superficial uterine veins. The total blood loss was 3000.0 ml. The patient’s hemodynamic parameters were restored during the operation. The patient spent three days in the intensive care unit. In the postoperative period, the woman received complex therapy including antibiotics, uterotonics, iron supplements, and anticoagulants. The postoperative period was without complications; the patient was discharged from the hospital on the 9th day after surgery in a satisfactory condition.
Conclusion: Hemoperitoneum due to the rupture of uterine vein or artery is a serious complication that requires rapid identification and urgent surgical intervention. In case when a pregnant patient has sudden abdominal pain accompanied by unstable hemodynamics, it is necessary to exclude the possibility of rupture of uterine blood vessels. Depending on the gestational age, patients may undergo laparotomy with or without cesarean section; reliable surgical hemostasis is obligatory.
Authors’ contributions: Tskhay V.B. – developing the concept and design of the study; Domracheva M.Ya., Brekhova I.S., Raspopin Yu.S. – collecting and processing the material; Tskhay V.B., Domracheva M.Ya., Brekhova I.S. – writing the text; Tskhay V.B., Raspopin Yu.S. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia.
Patient Consent for Publication: The patient provided an informed consent for the publication of her data and associated images.
For citation: Tskhay V.B., Domracheva M.Ya., Brekhova I.S., Raspopin Yu.S.
Massive obstetric hemorrhage caused by spontaneous rupture of uterine blood vessels.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (7): 171-176 (in Russian)
https://dx.doi.org/10.18565/aig.2024.144
Keywords
intra-abdominal hemorrhage
pregnancy
case report
complication
uterine artery rupture
uterine vein rupture
surgical hemostasis
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Received 19.06.2024
Accepted 10.07.2024
About the Authors
Vitaly B. Tskhay, Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology of the Medical Faculty, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 660022, Russia, Krasnoyarsk, P. Zheleznyak str., 1, +7(923)287-21-34, tchai@yandex.ru,https://orcid.org/0000-0003-2228-3884
Marina Ya. Domracheva, PhD, Associate Professor at the Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 660022, Russia, Krasnoyarsk, P. Zheleznyak str., 1, +7(908)221-05-84, m-domracheva@mail.ru, https://orcid.org/0000-0002-5798-4659
Irina S. Brekhova, PhD, Associate Professor at the Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 660022, Russia, Krasnoyarsk, P. Zheleznyak str., 1, +7(913)535-83-05, ibrehova@mail.ru
Yuri S. Raspopin, PhD, Teaching Assistant at the Department of Anesthesiology and Reanimatology, Institute of Postgraduate Education, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, 660022, Russia, Krasnoyarsk, P. Zheleznyak str., 1; Head of the Department of Anesthesiology and Reanimation No. 2, Krasnoyarsk Regional Clinical Center for Maternal and Child Health, +7(950)413-87-48, oar24@mail.ru, https://orcid.org/0000-0001-5550-1628
Corresponding author: Vitaly B. Tskhay, tchai@yandex.ru
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