1. Introduction
Spontaneous uterine vessels rupture is a very rare condition and its etiology is unknown. The diagnosis is very difficult and often it is discovered during laparotomy (1). There are a few case reports in the literature.
Nguessan KL et al. reported a case of spontaneous rupture of uterine varices in the third trimester. There was a rapid onset of maternal collapse with acute fetal distress and only emergency laparotomy allowed for etiological diagnosis and treatment (2).
Andres-Oros et al. reported two cases of twin pregnancies on the third trimester with spontaneous uterine venous rupture. In one case, the bleeding ended by compression. In the second one, which was required the vein suture, the diagnosis took place after the fetal death (3).
Berisavac et al. reported a case of spontaneous hematoperitoneoum in the third trimester of twin pregnancy. Because of the deteriorated condition of the patient, it was decided to perform laparotomy, which established the diagnosis of ruptured venous varices on the posterior wall of the uterus. Delivery was performed by cesarean section. The post operative period was uneventful (4).
2. Case Presentation
Our case is a 32-year-old primigravid woman who was admitted on March, 24th, 2014 at 11 pm to the emergency room at Ahvaz Aria Hospital. She was presented with abdominal and flank pain. On the examination, she was found to have a pulse rate of 82 beat/min and a blood pressure of 100/80 mmHg. She was afebrile at 37°C (orally) and FHR was 146/min. Abdominal examination revealed mild uterine contraction. General examination was otherwise unremarkable.
3. Discussion
Investigation on admission revealed hemoglobin of 8.4 g/dL. Ultrasound scan confirmed the presence of a live single fetus with gestational age about 30 weeks and 3 days. She was admitted to the obstetric ward for observation and management of preterm labor. Over the subsequent 3 hours, she had a hemoglobin drop (Hb = 7.9 g/dL) and developed signs of acute abdomen. An urgent surgical consult was requested. The surgical senior register reviewed the patient and with a differential diagnosis of peritonitis (surgical acute abdomen), an urgent laparotomy was arranged. The laparotomy was performed by the gynecologist and general surgeon. She was found to have 2 liters free blood and clot in her pelvis with an active bleeding from superficial vessels on fundus and body of uterus. At first, we determined to control the bleeding, but fragile tissue forced us to perform cesarean section. Then, a male fetus by gestational age of about 30 weeks was born. The placental site was anterior not prevail, and finally the superficial vessels were lighted. Now the infant is 11 months old and is growing well.
To conclude, in every pregnant woman with hemodynamic unstable condition, the possibility of uterine vessels rupture should be kept in mind.
