Complications of Haemoperitoneum due to Sexual Encounter in Pregnancy: A Case Study

Ni Ni Soe, Mon Mon Yee, Khin May Thaung
In: Research Journal of Pharmacy and Technology · 2022 · pp. 3659–3662 · doi:10.52711/0974-360x.2022.00613 · W4297833221
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This case study reports a 31-year-old pregnant woman who developed haemoperitoneum after sexual intercourse due to rupture of tortuous uterine vessels, necessitating an emergency caesarean section.

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This paper reports a rare case of life-threatening haemoperitoneum in a 31-year-old woman’s first pregnancy after sexual intercourse at 33 weeks and 4 days, presenting with acute abdominal pain without a history suggestive of endometriosis or fibroids. Using clinical monitoring (normal initial CTG followed by later unprovoked fetal decelerations) and imaging/operative findings, the authors suspected intra-abdominal bleeding and performed an emergency caesarean section, revealing about 800 mL of hemoperitoneum and a 1 cm defect over the right posterior fundus with active bleeding from a tortuous subserosal uterine vessel. The authors note that the mechanism is not fully known and outline hypothesized contributing factors, while emphasizing limitations inherent to case-report evidence and the need for thorough history-taking to exclude other diagnoses such as ruptured ectopic pregnancy or corpus luteal cyst. Relevance to endometriosis: the paper discusses that spontaneous haemoperitoneum in pregnancy complicated by endometriosis may occur, though the presented case itself specifically reports no history suggestive of endometriosis.

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Abstract

Haemoperitoneum secondary to a rupture of tortuous vessels from the serosal surface of the right uterine fundal region after coitus is a rare but life-threatening condition. This case demonstrates that even a very rare diagnosis should be considered, especially when dealing with patients with atypical presentations. This case report evidences a 31-year-old woman in her first pregnancy, presenting to our hospital triage at night for abdominal pain after sexual intercourse at a gestational age of 33 weeks and 4 days, and there was no history suggestive of endometriosis or fibroids. Apart from mild pain and slight pallor, she was stable. Her initial CTG was normal, but we noted two unprovoked decelerations about 8 and 10 hours after admission. During the morning rounds review, intra-abdominal bleeding was highly suspected and an emergency caesarean section was arranged. The on-call surgeon was also alerted, and a class I caesarean section was performed through the midline sub-umbilical incision. About 800 ml of intraoperative hemoperitoneum was noted upon opening the peritoneum. A male infant weighing 2.3 kg was delivered. Clear liquor was noted. Meanwhile, a small defect of about 1 cm in diameter with active bleeding from the underlying tortuous vessel was noted over the right posterior wall of the fundus. The underlying myometrium was intact and there was neither through nor through tear nor perforation. Discussion: The precise mechanism for postcoital haemoperitoneum due to rupture of uterine subserosal vessels is not known, but it is hypothesized that: pregnancy-with the increased friability of the tissues and fixation of the genital tract coincident with gestation; vigorous intercourse; coital positions; vaginismus and genital disproportion are the possible explanations. A complete gynaecological history, including endometriosis, fibroids, pelvic inflammatory disease, and any recent surgical procedures, is required to make a diagnosis. Ruptured ectopic pregnancy and ruptured corpus luteal cyst are on the top of the list of diagnoses in the early stage of pregnancy. The majority of such cases do not voluntarily admit the preceding act of coitus during initial presentation, and care must be taken to elicit a detailed sexual history. Interestingly, spontaneous haemoperitoneum in pregnancy complicated by endometriosis may occur during pregnancy. Conclusion: The study concludes that pregnant women with a history of the recent coitus present with acute abdominal pain, even in the absence of vaginal bleeding, haemoperitoneum has to be considered. On the other hand, idiopathic or spontaneous bleeding should be kept in mind even if there is no possible explanation.
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Abstract

Haemoperitoneum secondary to a rupture of tortuous vessels from the serosal surface of the right uterine fundal region after coitus is a rare but life-threatening condition. This case demonstrates that even a very rare diagnosis should be considered, especially when dealing with patients with atypical presentations. This case report evidences a 31-year-old woman in her first pregnancy, presenting to our hospital triage at night for abdominal pain after sexual intercourse at a gestational age of 33 weeks and 4 days, and there was no history suggestive of endometriosis or fibroids. Apart from mild pain and slight pallor, she was stable. Her initial CTG was normal, but we noted two unprovoked decelerations about 8 and 10 hours after admission. During the morning rounds review, intra-abdominal bleeding was highly suspected and an emergency caesarean section was arranged. The on-call surgeon was also alerted, and a class I caesarean section was performed through the midline sub-umbilical incision. About 800 ml of intraoperative hemoperitoneum was noted upon opening the peritoneum. A male infant weighing 2.3 kg was delivered. Clear liquor was noted. Meanwhile, a small defect of about 1 cm in diameter with active bleeding from the underlying tortuous vessel was noted over the right posterior wall of the fundus. The underlying myometrium was intact and there was neither through nor through tear nor perforation. Discussion: The precise mechanism for postcoital haemoperitoneum due to rupture of uterine subserosal vessels is not known, but it is hypothesized that: pregnancy-with the increased friability of the tissues and fixation of the genital tract coincident with gestation; vigorous intercourse; coital positions; vaginismus and genital disproportion are the possible explanations. A complete gynaecological history, including endometriosis, fibroids, pelvic inflammatory disease, and any recent surgical procedures, is required to make a diagnosis. Ruptured ectopic pregnancy and ruptured corpus luteal cyst are on the top of the list of diagnoses in the early stage of pregnancy. The majority of such cases do not voluntarily admit the preceding act of coitus during initial presentation, and care must be taken to elicit a detailed sexual history. Interestingly, spontaneous haemoperitoneum in pregnancy complicated by endometriosis may occur during pregnancy. Conclusion: The study concludes that pregnant women with a history of the recent coitus present with acute abdominal pain, even in the absence of vaginal bleeding, haemoperitoneum has to be considered. On the other hand, idiopathic or spontaneous bleeding should be kept in mind even if there is no possible explanation. Cite this article: Ni Ni Soe, Mon Mon Yee, Khin May Thaung. Complications of Haemoperitoneum due to Sexual Encounter in Pregnancy: A Case Study. Research Journal of Pharmacy and Technology. 2022; 15(8):3659-2. doi: 10.52711/0974-360X.2022.00613 Cite(Electronic): Ni Ni Soe, Mon Mon Yee, Khin May Thaung. Complications of Haemoperitoneum due to Sexual Encounter in Pregnancy: A Case Study. Research Journal of Pharmacy and Technology. 2022; 15(8):3659-2. doi: 10.52711/0974-360X.2022.00613 Available on: https://rjptonline.org/AbstractView.aspx?PID=2022-15-8-55

References

1. Ferrara BE, Murphy WM. The pains of love: hemoperitoneum following sexual intercourse. JAMA. 1986 Apr 4; 255(13):1708-9. 2. Chaar A, Abdallah W, Kharrat R, Nassar M. Splenic rupture after sexual intercourse in a pregnant woman: an extremely rare case. Future Science OA. 2021 Oct; 7(9):FSO741. 3. McColgin SW, Williams LM, Sorrells TL, Morrison JC. Hemoperitoneum as a result of coital injury without associated vaginal injury. American Journal of Obstetrics and Gynecology. 1990 Nov 1; 163(5):1503-5. 4. Dickinson RL. Human Sex Anatomy: a Topographical Hand Atlas. Williams & Wilkins; 1949. 5. Sim Y, Kim J, Jeong Y, Rheu C, Chae H. Spontaneous Hemoperitoneum in Pregnancy (SHiP) complicated by endometriosis: A case report. Obstet Gynecol. 2020; 4:1-2. 6. Owie E. Incidental hemoperitoneum from ruptured superficial uterine veins in twin pregnancy. Tropical Journal of Obstetrics and Gynaecology. 2018; 35(3):367-9. 7. Xu Y, Zhou Y, Xie J, Yin X, Zhang X. Intraperitoneal hemorrhage during pregnancy and parturition: Case reports and literature review. Medicine. 2019 Aug; 98(35). Research Journal of Pharmacy and Technology (RJPT) is an international, peer-reviewed, multidisciplinary journal.... Read more >>> RNI: CHHENG00387/33/1/2008-TCDOI: 10.52711/0974-360X 1.3 2021CiteScore 56th percentile Powered by

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