Endometriosis scar disruption may lead to "spontaneous hemorrhage in pregnancy" and can be life-threatening.
Jun 28, 2021
An alert for obstetricians to suspect for spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis.
Key Points
Importance:
- Obstetricians should be alert for spontaneous hemorrhage occurring in pregnant patients with a history of advanced-stage endometriosis.
Highlights:
- Endometriosis scar disruption may lead to "spontaneous hemorrhage in pregnancy" and can be life-threatening for both mother and baby.
. Although spontaneous hemoperitoneum is a rare condition in pregnant women with endometriosis, suspicion should raise when patients have signs of hypovolemic shock or sudden-onset pain during their labor. Endometriosis is a well-known disease that can cause spontaneous intraperitoneal hemorrhage in pregnancy due to stretching and tearing of dense adhesions.
What's done here:
- This is a case report about a 32 years old 40 weeks pregnant woman with advanced endometriosis.
- She had a cesarean delivery for cord prolapse, and was found to have massive intraperitoneal bleeding.
- The cause and the consequences are widely discussed to draw attention to the occurrence of "pregnancy spontaneous hemoperitoneum".
Case summary:
- Sudden supine hypotension and fetal bradycardia occurred after epidural intervention to provide pain relief due to intense contractions.
- Hemoglobin levels dropped when the decision of the cesarean section had been made.
- During the cesarean delivery for cord prolapse, intraabdominal massive bleeding visualized and evacuated before the baby was delivered.
Lay Summary
Kollikonda et al from Cleveland Clinic Women's Health Institute, Cleveland, Ohio, US penned a case report about their hemoperitoneum experience during labor, which was recently published in the "Journal of Obstetrics and Gyneaecology Canada". The aim is to warn obstetricians about the occurrence of spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis.
Apart from the vascular nature of endometriotic adhesions and their low elasticity, repeated surgical resections may also be the predisposing factors of adhesions to become more prone to tearing under the hormonal influence during pregnancy. Clinical symptoms of hemoperitoneum are sudden abdominal distention and pain while diagnosis could be made easily by ultrasound imaging. However, these symptoms of hemoperitoneum become unrecognizable by pregnancy and epidural anesthesia.
The situation causing spontaneous intraperitoneal bleeding and the complexity could be ignored, or misinterpreted in pregnancy. Rapid diagnosis and the differential diagnosis of this emergency situation is critical, as it may be life-threatening for both mother and baby.
Research Source: https://pubmed.ncbi.nlm.nih.gov/33798766/
spontaneous pregnancy hemoperitenoum cesarian section uterine laceration dense adhesions endometriois.
