Vaginal Hemorrhage Associated with Decidualized Rectovaginal Deep Infiltrating Endometriosis during the Third Trimester of Pregnancy: A Case Report

Jeong‐Won Oh, Eun Ji Lee, Yoon-Mi Jin
Journal of the Korean Society of Radiology · 2022 · vol. 83(5) , pp. 1121 · doi:10.3348/jksr.2022.0026 · PMID:36276199 · PMC9574287 · W4307234049
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes the first instance of spontaneous massive vaginal bleeding from decidualized rectovaginal deep infiltrating endometriosis during the late third trimester of pregnancy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This 2022 case report studied a 33-year-old primigravid woman who developed spontaneous massive vaginal bleeding at 36 weeks’ gestation, with earlier history suggestive of rectovaginal deep infiltrating endometriosis (DIE); the authors used pelvic exam findings and transvaginal ultrasonography/Doppler, contrast CT, MRI, placental evaluation, and ultimately histopathology. Imaging showed a highly vascular rectovaginal pouch lesion with suspected pseudoaneurysm/active bleeding, and despite emergency cesarean delivery, severe bleeding persisted until contrast-directed uterine artery embolization achieved hemostasis. Histology confirmed decidualized endometriosis in the vaginal lesion with focal ischemic necrosis, while the placenta showed findings consistent with placental abruption. As a single-case report, the study is limited in generalizability, but it links ectopic decidualization of rectovaginal DIE to life-threatening third-trimester hemorrhage. This paper is centrally about endometriosis — specifically, a case of decidualized rectovaginal deep infiltrating endometriosis causing massive vaginal hemorrhage during the third trimester of pregnancy.

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Abstract

Endometriosis-related symptoms are believed to be alleviated during pregnancy. However, pregnancy complications, such as pseudoaneurysm of the uterine artery, rupture of ovarian or uterine vessels, and intraabdominal bleeding from decidualized deep infiltrating endometriosis (DIE) lesion have been rarely reported. Owing to the potential risk of rupture and resultant life-threatening complications, proper diagnosis and close monitoring of decidualized endometriotic lesion are very important despite its low relative risk. Till date, massive vaginal bleeding from decidualized rectovaginal DIE during pregnancy has not been in English literatures. Here, we present the first case of spontaneous massive vaginal bleeding due to decidualized rectovaginal DIE that occurred in the late third trimester of pregnancy.

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endometriosisdie_deep_infiltrating

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