Detection of spontaneous hemoperitoneum in a pregnancy complicated with endometriosis during caesarean section - a case report

Sonali Chauhan, Jiten R. Sharma, Jiten Sharma, Bhumika Arora, Shivika Mittal, Rita Mittal
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 10(1) , pp. 401 · doi:10.18203/2320-1770.ijrcog20205809 · W3116898713
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This case report describes the intraoperative detection of spontaneous hemoperitoneum in a pregnant woman with endometriosis during a cesarean section.

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This case report describes a primigravida at term who underwent emergency caesarean section for non-reassuring fetal heart rate and was found intraoperatively to have spontaneous hemoperitoneum along with multiple endometriotic lesions on the posterior uterine surface and in the pouch of Douglas. Bilateral ovaries were adherent to endometriotic growth. The authors report that the patient remained stable postoperatively and was discharged on postoperative day 4, while the report frames endometriosis as a potential risk factor for spontaneous hemoperitoneum in pregnancy. This paper is centrally about endometriosis — specifically, it links endometriosis-associated intraabdominal bleeding (spontaneous hemoperitoneum) discovered during caesarean section.

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Abstract

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. During pregnancy endometriosis and its related pain symptoms improve due to various metabolic, hormonal, immune and angiogenesis changes that occur in pregnancy. Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious pregnancy complication, which is associated with high rates of maternal and foetal morbidity and mortality. Endometriosis may be a potential risk factor for SHiP. Preformation of IVF on women with endometriosis may be a potential risk factor for SHiP. In gravid females with a history of endometriosis, severe abdominal pain, and a reduction of haemoglobin, physicians should always suspect SHiP because it is a life-threatening condition for both the mother and the baby. We are reporting a case of a primigravida with term gestation, taken up for emergency caesarean section in view of non-reassuring foetal heart rate. Intraoperatively there was evidence of hemoperitoneum and multiple endometriotic lesions on the posterior surface of uterus and Pouch of Douglas, Bilateral ovaries were adherent to the endometriotic growth on the posterior surface of uterus. Postoperatively, patient was stable and was discharged on postoperative day 4.
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Detection of spontaneous hemoperitoneum in a pregnancy complicated with endometriosis during caesarean section - a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20205809Keywords: Endometriosis, Pregnancy, Hemoperitoneum, Caesarean sectionAbstract Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. During pregnancy endometriosis and its related pain symptoms improve due to various metabolic, hormonal, immune and angiogenesis changes that occur in pregnancy. Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious pregnancy complication, which is associated with high rates of maternal and foetal morbidity and mortality. Endometriosis may be a potential risk factor for SHiP. Preformation of IVF on women with endometriosis may be a potential risk factor for SHiP. In gravid females with a history of endometriosis, severe abdominal pain, and a reduction of haemoglobin, physicians should always suspect SHiP because it is a life-threatening condition for both the mother and the baby. We are reporting a case of a primigravida with term gestation, taken up for emergency caesarean section in view of non-reassuring foetal heart rate. Intraoperatively there was evidence of hemoperitoneum and multiple endometriotic lesions on the posterior surface of uterus and Pouch of Douglas, Bilateral ovaries were adherent to the endometriotic growth on the posterior surface of uterus. Postoperatively, patient was stable and was discharged on postoperative day 4. Metrics References Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):177-200. Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril. 2009;92:1243-5. Bulletti C, Ellisabetta M, Battistoni CS. Endometriosis and Infertility. J Assist Reprod Genet. 2010;27(8):441-7. Tejaswini B, Chandushree, Kumar A, Bharati, Sumayya, Shruti K, et al. Incidental detection of atypical endometriosis during caesarean section. Endocrinal Metab Int J. 2018;6(5):324-86. Inoue T, Moriwaki T, Niki I. Endometriosis and spontaneous rupture of utero‐ovarian vessels during pregnancy. Lancet. 1992;340:240-1. Ginsburg KA, Valdes C, Schnider G. Spontaneous utero‐ovarian vessel rupture during pregnancy: three case reports and a review of the literature. Obstet Gynecol. 1987;69:474-6. Passos F, Calhaz-Jorge C, Graça LM. Endometriosis is a possible risk factor for spontaneous hemoperitoneum in the third trimester of pregnancy. Fertil Steril. 2008;89:251-2. Katorza E, Soriano D, Stockheim D, Mashiach R, Zolti M, Seidman DS, et al. Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy. Am J Obstet Gynecol. 2007;197:501. McArthur JW, Ulfelder H. The effect of pregnancy upon endometriosis. Obstet Gynecol Surv. 1965;20:709-33.

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