Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy

E Katorza, Eldad Katorza, Katorza E, Soriano D, D Soriano, David Soriano, D Stockheim, David Stockheim, Stockheim D, R Mashiach, Mashiach R, Zolti M, M Zolti, D S Seidman, Daniel S. Seidman, Seidman DS, E Schiff, Schiff E, M Goldenberg, Goldenberg M, Mordechai Goldenberg
American journal of obstetrics and gynecology · 2007 · vol. 197(5) , pp. 501.e1–501.e4 · doi:10.1016/j.ajog.2007.04.030 · PMID:17980188 · W2088625154
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This paper reports a case of severe intraabdominal bleeding originating from endometriotic lesions during the third trimester of pregnancy.

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Abstract

ObjectiveEndometriosis is known to be associated with an increased risk for early pregnancy complications, including ectopic pregnancy and miscarriage. However, little has so far been reported on complications linked to severe endometriosis occurring during the third trimester of pregnancy.Study designA retrospective review of 800 women attending the endometriosis clinic of the Sheba Medical Center during the years 2002-2006 was performed. Cases with severe endometriosis and associated complications during late pregnancy were identified.ResultsThree women were found who experienced significant intraabdominal bleeding in the third trimester of pregnancy attributed to a lesion resulting from severe endometriosis. The intraabdominal bleeding occurred between 26-29 weeks of gestation. In all cases the major presenting prenatal symptom was severe lower abdominal pain. The pain was not relieved by the administration of tocolytics or mild analgesics. Explorative laparotomy, performed in all 3 cases, revealed the presence of significant intraabdominal bleeding requiring immediate transfusion of blood products stemming from endometriotic lesions. Fetal complications occurred in all 3 cases.ConclusionThe symptoms of endometriosis are often relieved during pregnancy. Yet lesions caused by severe endometriosis can lead to significant intraabdominal bleeding during the third trimester of the pregnancy. Physicians must be aware that close antenatal follow-up and prompt intervention may be required in such cases.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Pregnancy Complications Pregnancy Complications Abdomen Abdominal Pain Abdominal Pain Endometriosis Endometriosis Female Hemoperitoneum Hemoperitoneum Humans Pregnancy Pregnancy Outcome Pregnancy Trimester, Third Retrospective Studies

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