Massive obstetric hemorrhage caused by spontaneous rupture of uterine blood vessels

Tskhay V.B., Domracheva M.Ya., Brekhova I.S., Raspopin Yu.S.

1) Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia; 2) Federal Siberian Research Clinical Center, Federal Medical and Biological Agency, Krasnoyarsk, Russia; 3) Krasnoyarsk Regional Clinical Center for Maternal and Child Health, Krasnoyarsk, Russia

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

References

  1. Le Gouez A., Mercier F.J. Major obstetric hemorrhage. Transfus. Clin. Biol. 2016; 23(4): 229-32. https://dx.doi.org/ 10.1016/j.tracli.2016.08.003.
  2. van Stralen G., Ruijten L.L.M., Kaptein A.A., Wolterbeek R., van Roosmalen J. Major obstetric hemorrhage: a follow-up survey on quality of life of women and their partners. J. Psychosom. Obstet. Gynaecol. 2018; 39(1): 38-46. https://dx.doi.org/10.1080/0167482X.2017.1286640.
  3. Шмаков Р.Г., Пирогова М.М., Васильченко О.Н., Чупрынин В.Д., Ежова Л.С. Хирургическая тактика при врастании плаценты с различной глубиной инвазии. Акушерство и гинекология. 2020; 1: 78-82. [Shmakov R.G., Pirogova M.M., Vasilchenko O.N., Chuprynin V.D., Ezhova L.S. Surgical tactics for placenta accreta with varying depths of invasion. Obstetrics and Gynecology. 2020; (1): 78-82. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1.78-82.
  4. Hu J., Yu Z.P., Wang P., Shi C.Y., Yang H.X. Clinical analysis of postpartum hemorrhage requiring massive transfusions at a tertiary center. Chin. Med. J. 2017; 130(5): 581-5. https://dx.doi.org/10.4103/0366-6999.200545.
  5. Канцурова М.Р., Рымашевский А.Н., Волков А.Е. Обоснование применения нового компрессионого шва для остановки гипотонического кровотечения у родильниц. Сибирское медицинское обозрение. 2022; 4: 66-72. [Kantsurova M.R., Rymashevsky A.N., Volkov A.E. Rationale for the use of a new compression suture to stop hypotonic bleeding in postpartum women. Siberian Medical Review. 2022; (4): 66-72. (in Russian)]. https://dx.doi.org/10.20333/25000136-2022-4-66-72
  6. Alturki F., Ponette V., Boucher L.M. Spontaneous retroperitoneal hematomas following uncomplicated vaginal deliveries: A case report and literature review. J. Obstet. Gynaecol. Can. 2018; 40(6): 712-5. https://dx.doi.org/10.1016/j.jogc.2017.08.045.
  7. Maroyi R., Ngeleza N., Kalunga K., Buhendwa C., Shahid U., Boij R. et al. Large retroperitoneal hematoma following vaginal delivery: A case report. J. Med. Case Rep. 2021; 15(1): 290. https://dx.doi.org/10.1186/s13256-021-02870-x.
  8. Mercier A.M., Caldwell M.G., Rabie N.Z., Pagan M., Ramseyer A.M., Magann E.F. Spontaneous uterine vessel rupture during pregnancy or in the puerperium: a review of the literature. Obstet. Gynecol. Surv. 2022; 77(4): 227-33. https://dx.doi.org/10.1097/OGX.0000000000001012.
  9. Цхай В.Б., Бакунина А.А. Спонтанный разрыв маточных сосудов во время беременности и родов. Обзор литературы. Женское здоровье и репродукция. 2021; 3(50). Доступно по: http://whfordoctors.su/statyi/spontannyj-razryv-matochnyh-krovenosnyh-sosudov-vo-vremja-beremennosti-i-rodov-obzor-literatury/ [Tskhai V.B., Bakunina A.A. Spontaneous rupture of uterine vessels during pregnancy and childbirth. Literature review. Women's Health and Reproduction. 2021; 3(50). (in Russian)]. Available at: http://whfordoctors.su/statyi/spontannyj-razryv-matochnyh-krovenosnyh-sosudov-vo-vremja-beremennosti-i-rodov-obzor-literatury/.
  10. Duhan N., Sangwan N., Rajotia N., Kadian Y.S., Singla S.L. Spontaneous uterine artery rupture at delivery. J. Obstet. Gynecol. India. 2013; 63(1): 72-3. https://dx.doi.org/10.1007/s13224-012-0142-z.
  11. Wang H.F., Rong S.R., Zhang A.H., Yang A.L., Liang Q. Shock caused by spontaneous rupture uterine vessels during puerperal period: a case report and literature review. Eur. Rev. Med. Pharmacol. Sci. 2021; 25(13): 4451-5. https://dx.doi.org/10.26355/eurrev_202107_26235.
  12. Xu Y., Zhou Y., Xie J., Yin X., Zhang X. Intraperitoneal hemorrhage during pregnancy and parturition: Case reports and literature review. Medicine (Baltimore). 2019; 98(35): e16300. https://dx.doi.org/10.1097/MD.0000000000016300.
  13. Redondo Villatoro A., Azcona Sutil L., Vargas Gálvez D., Carmona Domínguez E.,Cabezas Palacios M.N. Diagnosis and management of postpartum retroperitoneal hematoma: a report of 3 cases. Am. J. Case Rep. 2022; 23: e935787. https://dx.doi.org/10.12659/AJCR.935787.
  14. Naeh A., Bruchim I., Hallak M., Gabbay-Benziv R. Endometriosis-related Hemoperitoneum in Late Pregnancy. Isr. Med. Assoc. J. 2019; 21(8): 557-9.
  15. Kato M., Miyazaki Y., Kawamura H., Orisaka M., Kurokawa T., Yoshida Y. A 41-year-old woman with spontaneous hemoperitoneum in pregnancy at 28 weeks. Am. J. Case Rep. 2023; 24: e939330. https://dx.doi.org/10.12659/AJCR.939330.
  16. Mondelli B., Balais G., Erritty M., Minas V. Endometriosis-associated spontaneous major haemoperitoneum in pregnancy. BMJ Case Rep. 2024; 17(3): e257344. https://dx.doi.org/10.1136/bcr-2023-257344.
  17. Yang L., Liu N., Long Y. Intra-abdominal hemorrhage during pregnancy: Four case reports. World J. Clin. Cases. 2020; 8(14): 3074-81. https://dx.doi.org/10.12998/wjcc.v8.i14.3074.
  18. Van Coppenolle C., Jaillet L., Gallot D., Chabrot P., Delabaere A. Rupture d’un anévrisme de l’artère utérine en cours de grossesse traitée par embolisation [Rupture of an aneurism of the uterine artery during pregnancy treated by embolization]. Gynecol. Obstet. Fertil. Senol. 2019; 47(10): 761-4. (in French). https://dx.doi.org/10.1016/j.gofs.2019.08.006.
  19. O'Sullivan C., Saenz A. Jr. Uterine artery embolization during pregnancy. Proc. (Bayl. Univ. Med. Cent). 2022; 35(3): 377-8. https://dx.doi.org/10.1080/08998280.2022.2035188.

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

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.