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This case report describes two pregnant patients, including a primigravida with spontaneous conception, who presented with acute abdomen and were found to have spontaneous broad ligament hematomas during lower segment caesarean sections. Intra-operative exploration revealed previously undiagnosed endometriosis extending to the posterior surface of the uterus alongside the hematomas, which had not been identified pre-operatively. The authors note that such occurrences are extremely rare and emphasize the importance of thorough surgical exploration of the adnexa and peritoneal surfaces during cesarean deliveries to identify incidental findings. Relevance to endometriosis: this paper is centrally about endometriosis, specifically reporting incidental intra-operative discovery of endometriotic lesions in conjunction with a rare obstetric complication.
Abstract
Spontaneous broad ligament hematoma during pregnancy is an extremely rare obstetric emergency that can present with acute abdomen and hemodynamic instability. It is usually associated with trauma, uterine rupture, or vascular abnormalities. Association with endometriosis is uncommon, particularly in women with spontaneous conception. We present a rare case series of spontaneous broad ligament hematoma in a primigravida and another patient with previous vaginal delivery, both having spontaneous conception, having no presenting complaints other than obstetric indication for which lower segment caesarean section was done. Spontaneous hematomas were an incidental finding in both cases, where in previously undiagnosed endometriosis was identified intra-operatively with unusual spontaneous hematomas extending to the posterior surface of uterus. Every lower segment caesarean section should be complemented with thorough exploration of posterior surface and adnexa including the peritoneal surfaces to look for any endometriotic spot, hematoma or any other unusual finding before final closure to prevent any adversity of materno-fetal outcome.
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Unusual presentation of a spontaneous broad ligament hematoma during pregnancy unmasking endometriosis in a primigravida inadvertently: a rare case report
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263463Keywords:
Hematoma, Broad ligament, Lower segment caesarean section, SpontaneousAbstract
Spontaneous broad ligament hematoma during pregnancy is an extremely rare obstetric emergency that can present with acute abdomen and hemodynamic instability. It is usually associated with trauma, uterine rupture, or vascular abnormalities. Association with endometriosis is uncommon, particularly in women with spontaneous conception. We present a rare case series of spontaneous broad ligament hematoma in a primigravida and another patient with previous vaginal delivery, both having spontaneous conception, having no presenting complaints other than obstetric indication for which lower segment caesarean section was done. Spontaneous hematomas were an incidental finding in both cases, where in previously undiagnosed endometriosis was identified intra-operatively with unusual spontaneous hematomas extending to the posterior surface of uterus. Every lower segment caesarean section should be complemented with thorough exploration of posterior surface and adnexa including the peritoneal surfaces to look for any endometriotic spot, hematoma or any other unusual finding before final closure to prevent any adversity of materno-fetal outcome.
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Copyright (c) 2026 Deeksha Sharma, Ravi Mannan, Ritesh Sharma
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