Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review

Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review Yilin Meng, Xuan Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7522469/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Nov, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 20 You are reading this latest preprint version Abstract Background Spontaneous rupture of the spleen during pregnancy or after Delivery is an extremely rare, harmful and life-threatening complication that poses a major challenge to diagnosis and treatment. It also reviews the relevant literature to discuss the characteristics of patients with prenatal spontaneous splenic rupture. Case presentation A 33-year-old woman with spontaneous splenic rupture at 27 weeks of gestation is presented here in a case study. Despite the absence of a history of trauma and recognized risk factors, the patient exhibited symptoms of polyhydramnios accompanied by abdominal distension one week prior. One week later, the patient presented to the emergency department. They had an abdominal ultrasound. This revealed a large amount of ascites. This was not seen on a whole abdominal CT. This was to identify the location of bleeding. The patient also had a progressive decline in hemoglobin. There was also abnormal fetal umbilical artery blood flow. After a multidisciplinary consultation, emergency c-section and exploratory laparotomy were performed. The departments involved were surgery, gynecology, obstetrics, ultrasound, radiology and neonatology. After delivery of the fetus, exploration revealed an active haemorrhage. This was near the splenic hilum on the greater omentum. There was also a ruptured capsule at the splenic hilum. Following consultation with the surgeon and with the family's consent, a complete splenectomy was performed. The diagnosis of spontaneous splenic rupture was confirmed by postoperative paraffin-embedded pathology. This is a very rare case. Excessive amniotic fluid, increased abdominal pressure and rupture of the greater omentum and splenic capsule after omental traction are the current causes for concern. These result in intraperitoneal haemorrhage and haemorrhagic shock. Conclusion This case emphasizes the importance of monitoring amniotic fluid volume during pregnancy closely, as well as the early monitoring, diagnosis and treatment of acute abdomen induced by polyhydramnios. Active surgical intervention will help to improve maternal outcomes and prognosis. Figures Figure 1 Figure 2 Background At present, antepartum, intrapartum, and postpartum haemorrhage represents one of the primary causes of maternal mortality on a global scale[ 1 ]. Within the paradigm of optimal splenic function during pregnancy, the spontaneous or non-traumatic occurrence of splenic rupture is an exceptionally uncommon occurrence[ 2 , 3 ]. It is defined as occurring in the absence of any concomitant splenic injury, systemic disease, trauma, or evidence of splenic adhesions[ 4 , 5 ]. A major challenge in diagnosing this condition is the absence of specific symptoms during this delicate phase of development, potentially resulting in delayed diagnoses and adverse outcomes[ 6 ]. Splenic rupture, which can result in fatal injuries, is a potentially life-threatening complication that can occur in any type of trauma, with or without identifiable precipitating factors. Nevertheless, it must be noted that in certain cases, the mechanisms and causes of injury are multifactorial in nature and remain unclear. It has been posited by preceding writers that gestation itself can act as a risk factor for splenic rupture. This phenomenon is believed to be attributable to a combination of factors, chief among them being hypotension and variations in the positioning of abdominal organs. Case presentation This case study focuses on a 33-year-old pregnant woman who conceives naturally at a suitable age. The patient has a regular menstrual cycle, with her last menstrual period occurring on 30 December 2024. The estimated gestational age is 27 weeks and 2 days. The patient was referred from a lower-level medical facility, having experienced a one-day history of abdominal discomfort. This is the subject's first pregnancy. There is no record of any significant illnesses, surgery or trauma. It is evident that the patient has participated in scheduled antenatal consultations throughout the gestational period, with all assessments conducted in a consistent and satisfactory manner. The patient's height was recorded at 164 cm, and a weight of 65.5 kg was determined, indicating a fair nutritional status. A routine ultrasound scan conducted one week prior revealed polyhydramnios (amniotic fluid depth 8.2 cm, amniotic fluid index 26.9), although the patient reported no subjective symptoms. On the day of the presentation, abdominal distension and pain were observed at 7:00 am following defecation. Following the occurrence of a second bowel movement at 10:00 am, there was an improvement in the symptoms. There was a recurrence of intense abdominal pain at 12:00am, which necessitated presentation at a local hospital. In view of the findings of the antenatal ultrasound, which revealed a left adnexal cyst measuring 2.5 × 1.7 cm, the local hospital diagnosed ovarian cyst torsion, with the possibility of rupture. Treatment with magnesium sulphate and anti-inflammatory agents did not result in a significant improvement. A subsequent ultrasound examination that evening revealed the presence of 5 cm of abdominal fluid, in addition to persistent, diffuse abdominal pain. This prompted the patient to be transferred to our hospital. Upon admission, the patient exhibited stable vital signs, with blood pressure recorded at 100/70 mmHg and a pulse rate of 70 beats per minute. The fundal height was measured at 31 cm; however, assessment of the abdominal circumference was not possible due to the patient's inability to cooperate. The patient reported no history of trauma. A physical examination was conducted, which revealed tenderness throughout the abdomen, most pronounced in the upper abdomen. Positive signs of peritoneal irritation were also observed. The uterus exhibited signs of tension, but no discernible contractions were observed. No vaginal bleeding was observed, and the foetal heart rate was found to be within the normal range. The patient attended the emergency department that evening with a hemoglobin level of 81 g/dl. Emergency abdominal ultrasound revealed maternal abdominal fluid accumulation, with the deepest pocket located in the left abdominal cavity at approximately 7.7 cm depth, containing scattered flocculent echoes. Furthermore, the presence of fluid was observed in the prehepatic space at a depth of approximately 2.1 cm, as well as in the hepatorenal space at a depth of approximately 1.9 cm. The mean fetal heart rate was approximately 128 beats per minute, and the umbilical artery S/D ratio was 4.1. The amniotic fluid depth was measured at approximately 11.1 cm, and the amniotic fluid index was recorded at 34 cm. A whole abdominal plain CT scan revealed pelvic and abdominal fluid accumulation; no other significant abnormalities were noted. The patient was urgently admitted to the ward for close monitoring. During the monitoring period, vital signs remained stable. However, subsequent biochemical analyses revealed a progressive decline in hemoglobin levels (02:21 78 g/dl, 04:56 72 g/dl, 08:21 71 g/dl). A subsequent ultrasound examination the following morning revealed the persistence of abdominal fluid, with a depth of approximately 7.0 cm. The foetal umbilical artery S/D ratio increased to 5.3, with a fetal heart rate of approximately 140 beats per minute. In view of the progressive hemoglobin decline, intra-abdominal haemorrhage and suspected foetal distress could not be ruled out. The patient's heart rate had increased to 120–130 beats per minute, with blood pressure measuring between 100–120/70–80 mmHg. Following a series of detailed explanations regarding the condition, the patient and her family indicated their desire to terminate the pregnancy. The patient underwent an emergency caesarean section, which was performed in conjunction with an exploratory laparotomy. A caesarean section was performed on the lower segment of the uterus. The amniotic fluid was found to be clear. A male infant with a birth weight of 1230g was delivered by caesarean section. Following resuscitation by the obstetrician-gynecologist during delivery, the APGAR scores were 5/1 minute and 10/5 minutes. The infant was subsequently transferred to the neonatal ward for inpatient treatment. The patient demonstrated laxity and weakness across all layers of the abdominal wall, with a thin muscular layer. Upon entering the abdominal cavity, approximately 2000 ml of free blood with clots was observed, alongside extensive clots in the upper abdomen and perihépatic region. Intraoperative examination of the uterus revealed no localized haemorrhage or rupture, with no evidence of placental abruption or uterine rupture. A thorough examination of the adnexa revealed the presence of a 3×3 cm chocolate cyst on the left ovary and a 1×1 cm cyst on the left fallopian tube. The absence of any indications of torsion or rupture was noted, and both were completely excised during the surgical procedure. Subsequently, the surgeon extended the abdominal incision vertically around the umbilicus to approximately 30 cm in length, thus enabling exploration of the upper and middle abdominal cavities. Active bleeding was observed on the greater omentum in the proximity of the splenic hilum along the greater curvature of the stomach. A rupture was identified in the splenic capsule at the hilum, accompanied by adjacent adhesions on the greater omentum. This was interpreted as splenic rupture caused by traction from omental adhesions, necessitating splenectomy. The surgical procedure was conducted without incident, resulting in approximately 300 ml of intraoperative blood loss. This necessitated the transfusion of two units of packed red blood cells. Postoperatively, the patient was transferred to the intensive care unit for further management. Following a period of two days involving intensive care, the patient's condition stabilized. She was subsequently discharged from the obstetrics ward and discharged home after six days. Subsequent postoperative paraffin-embedded histopathological examination (Fig. 1 ) confirmed the presence of splenic rupture. Beyond the hematoma resulting from this rupture, no other pathologies such as splenic artery aneurysms were identified histologically. The infant is currently undergoing treatment in the neonatal intensive care unit. At the time of writing, no sequelae have been reported. Materials and methods Literature review The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram was used for the literature review. In September 2025, a systematic search was conducted in the MedLine, Embase, and Cochrane Library databases without any date restrictions. A review of the published literature was conducted using the keywords 'splenic rupture' and 'pregnancy' in the MedLine, Embase, and Cochrane Library databases. A secondary reference review of these publications was also conducted to identify any additional relevant articles and case reports. The databases used for the literature review and the results obtained are listed below. EndNote was used for reference management and duplicate detection. PRISMA diagram The search included the MEDLINE (n = 505), Embase(n = 544), and Cochrane Library databases. A total of 504 references were removed, with 493 duplicates identified manually excluded. The number of studies screened was 556, of which 479 were excluded. The number of studies sought for retrieval was 77. The number of studies assessed for eligibility was 77, of which 67 were excluded. As a result, the number of studies included in the review was 10 (Fig. 2 ). Inclusion criteria The pregnant woman was diagnosed as spontaneous splenic rupture Spontaneous splenic rupture occurs before delivery. The literature was published between 1995 and 2025. Exclusion criteria Patients with history of trauma or disease. Discussion and literature review The spontaneous rupture of the normal spleen in the absence of a history of trauma is an extremely rare clinical event. As presented in Table 1 , a number of previous case reports were identified which exhibited a comparable presentation to that of the present case, and which were diagnosed with prenatal splenic rupture during pregnancy from 1995 to 2025. Table 1 Past studies reporting cases of prenatal spontaneous splenic rupture Author and country year Age, and parity Gestational Age (Weeks) Radiological or Clinical Findings Intervention Outcome Xu China[ 7 ] 2023 25, G1P0 40 abdominal pain and fetal bradycardia Cesarean delivery and splenectomy Mother and infant survived Yakub R, UK[ 8 ] 2017 37, G2P1 39 + 4 tachycardic and hypotensive, A Focused Assessment with Sonography in Trauma (FAST) scan suggested free fluid in the abdomen Cesarean delivery and splenectomy Mother and infant survived Adil Elghanmi, Morocco[ 9 ] 2015 26, G2P1 35 upper abdominal pain, vertigo and general weakness at home, Ultrasonographic exam revealed an extensive intra-abdominal fluid Cesarean delivery and splenectomy Mother and fetus died Wang Cecina[ 4 ] 2011 30, G1P0 33.7 acute hypotension and tachycardia Cesarean delivery and splenectomy Mother survived and fetus died Di Vella et al., Italy[ 10 ] 2008 28, G3P2 33.6 hemorrhagic shock Cesarean delivery and splenectomy Mother died, infant survived Turan et al., Turkey[ 11 ] 2007 28, G2P1 20 admitted to the hospital dead after collapsing Tracheostomy and cardiopulmonary resuscitation Mother and fetus died Riches et al., Israel[ 12 ] 2005 32, G4P3 34 fetal bradycardia, a diffusely tender and distended abdomen, with signs of peritoneal irritation. Cesarean delivery and splenectomy Mother and infant survived Manda et al., UK[ 13 ] 2004 30, G3P2 35 fetal compromise, Ultrasonography confirmed an intraperitoneal fluid collection Cesarean delivery and splenectomy Mother and infant survived Bajic et al., Croatia [ 14 ] 2004 38, G༟P༟ 38 haemorrhagic shock and increasing abdominal pain Cesarean delivery and splenectomy Mother and infant survived Popli et al., India[ 15 ] 2004 20, G2P1 36 Hypotension, intraabdominal bleeding Cesarean delivery and splenectomy Mother survived, infant died Current case 2025 33, G1P0 27 + 2 Hemoglobin decreasing, Ultrasonography confirmed intra-abdominal fluid Cesarean delivery and splenectomy Mother and infant survived Spontaneous splenic rupture during pregnancy is an exceptionally rare clinical occurrence. The term "spontaneous rupture of a normal spleen" refers to the occurrence of rupture without the presence of prior trauma[ 4 , 6 , 16 ]. During exploration, the splenic parenchyma, vascular system, and capsule should appear macroscopically and histologically normal. The etiology of spontaneous rupture of a normal spleen during pregnancy remains inconclusive. It has been hypothesized that splenic enlargement during pregnancy, increased blood volume, and reduced peritoneal cavity space may be implicated in the pathogenesis of rupture[ 4 ]. The presence of circulating hormones, such as estrogen and progesterone, has been demonstrated to induce structural alterations in the spleen[ 4 , 10 ]. This has been shown to potentially elevate the risk of splenic rupture during pregnancy, even in cases of minor trauma[ 10 ]. Spontaneous splenic rupture, although rare, is typically observed in cases occurring during the late gestational period and the postpartum phase[ 2 , 16 ]. However, spontaneous splenic rupture in mid-pregnancy, as in the case we report, is even more uncommon. As gestational age increases, the uterus, which is responsible for the gestation of the foetus, exerts an upward pressure on the abdominal organs, thereby altering their physiological positioning compared to that observed in non-pregnant individuals[ 7 ]. By the final trimester, the pressure exerted by the uterus on the abdominal structures has reached its zenith. In this particular instance, the patient exhibited polyhydramnios one week prior to presentation, accompanied by rapid fundal height increase and signs of uterine hypertonicity. This finding suggests that, despite being in the mid-pregnancy stage, the patient's uterine enlargement was significantly pronounced. Consequently, compression occurred at the greater curvature of the stomach and the adjacent greater omentum, causing them to adhere to neighboring organs. In instances where the patient experienced discomfort during defecation, this resulted in an increase in intra-abdominal pressure. Consequently, traction was exerted on the splenic hilum, leading to localized rupture. This resulted in haemorrhage and subsequent shock, representing the probable mechanism for the spontaneous splenic rupture observed in this case. This emphasizes the necessity for increased vigilance in pregnant women with polyhydramnios, irrespective of gestational age, necessitating a comprehensive evaluation for acute abdominal conditions when abdominal pain manifests. The diagnosis of splenic rupture during pregnancy is challenging due to the similarity of its signs and symptoms to those of other common obstetric acute abdominal emergencies, such as uterine rupture and placental abruption[ 7 , 9 ]. The classic presentation of spontaneous splenic rupture is characterized by the presence of free abdominal haemorrhage, including symptoms such as abdominal pain, haemorrhagic shock and decreased hemoglobin levels. In the cases that have been documented, a number of patients who have experienced spontaneous splenic rupture have presented primarily with sudden syncope in the home environment[ 11 ]. The challenge of timely recognition and management of splenic rupture during pregnancy results in high rates of maternal and foetal mortality. The predominant cause of maternal death is typically massive haemorrhage, accompanied by haemorrhagic shock and consumptive coagulopathy. Acute maternal haemorrhage leads to a sudden reduction in uteroplacental perfusion, causing foetal distress and ultimately foetal death. Fortunately, in this case, the patient underwent a caesarean section and splenectomy in a timely manner. The mother exhibited a positive recovery trajectory and was subsequently discharged from the hospital. The foetus, meanwhile, received prompt treatment in the paediatric department. This marks the earliest recorded gestational age of foetal survival following spontaneous splenic rupture. Conclusion This case report concerns a case of spontaneous splenic rupture in a female patient with polyhydramnios during the mid-pregnancy period. This represents the earliest gestational age of foetal survival following spontaneous splenic rupture reported worldwide to date. The patient presented with upper abdominal pain and intra-abdominal haemorrhage, with no history of trauma. The patient exhibited rapid, progressive hemoglobin decline, haemorrhagic shock, and foetal distress. Consequently, an emergency caesarean section and exploratory laparotomy were performed, followed by prompt total splenectomy upon confirmation of the diagnosis. The expeditious clinical recognition, diagnosis, and timely surgical intervention are of paramount importance for the effective management of this condition and the determination of prognosis. The splenectomy and subsequent histopathological examination revealed no evidence of malignancy or other pathologies, thus confirming the diagnosis of spontaneous splenic rupture. This case underscores the importance of investigating acute abdominal emergencies during pregnancy, even in the absence of trauma or precipitating factors. Clinicians should remain vigilant for this uncommon complication and consider it within the framework of a differential diagnosis, thereby ensuring expeditious and efficacious management. Declarations Ethics approval and consent to participate Written consent was obtained from the patient to participate. According with The Consent for publication Written informed consent for publication was obtained from the patient. Competing interests The authors declare no competing interests. Funding Not applicable Author Contribution Yilin Meng conceptualized the study, designed the case - report structure, and led the literature review, integrating case details with findings for a coherent narrative. She ensured high scientific and clinical standards.Xuan Zhang analyzed the case, collected and organized patient data, contributed to the clinical implications section, and assisted in statistical analysis. She also participated in drafting and revising the manuscript.Both authors approved the final version and are accountable for the work's integrity. Acknowledgement We would like to thank the patient and her family for consenting to publish this case report. Data Availability The datasets analyzed during the current study are not publicly available dueto protection of the patient’s privacy but are available from the correspondingauthor on reasonable request (email: [email protected] ). References Sharma C, Patel H. Spontaneous Splenic Rupture Following Vaginal Delivery in Severe Preeclampsia: A Case Report. Cureus. 2023;15(12):e50266. Ahmed RA, Yaseen FA, Aljudaibi RS, Ahmed NA. A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia. Cureus. 2024;16(4):e58246. Londero F, Cociancich G. Spontaneous rupture of the spleen in labor. Am J Obstet Gynecol. 2000;183(3):782–3. Wang C, Tu X, Li S, Luo G, Norwitz ER. Spontaneous rupture of the spleen: a rare but serious case of acute abdominal pain in pregnancy. J Emerg Med. 2011;41(5):503–6. Orloff MJ, Peskin GW. Spontaneous rupture of the normal spleen; a surgical enigma. Int Abstr Surg. 1958;106(1):1–11. Korkontzelos I, Kyrochristou G, Stefanou S, Spyropoulou K, Mpourazanis G, Theodorou DJ, Papanikolaou A, Korkontzelou PD, Georgakopoulou VE, Papalexis P. Splenic Rupture in an Elective Cesarean Section: A Possible Iatrogenic Event. Cureus. 2023;15(11):e48478. Xu H, Lu JP. Spontaneous rupture of the spleen at full term during pregnancy: a case report. J Int Med Res. 2023;51(9):3000605231196818. Yakub R, Ahmad G, Rana N, Titi S. A rare case of 'spontaneous' splenic rupture in pregnancy: A successful outcome for mother and baby against the odds. J Obstet Gynaecol. 2017;37(3):385–6. Elghanmi A, Mohamed J, Khabouz S. Spontaneous splenic rupture in pregnancy. Pan Afr Med J. 2015;21:312. Di Vella G, Arpaio A, Marzullo A, Colonna M. Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases. Forensic Sci Int. 2008;176(2–3):e1–5. Turan N, Oghan F, Boran T. Spontaneous rupture of splenic vein in a pregnant woman during a religious ritual. J Forensic Leg Med. 2007;14(7):440–3. Reches A, Almog R, Pauzner D, Almog B, Levin I. Spontaneous splenic rupture in pregnancy after heparin treatment. BJOG. 2005;112(6):837–8. Manda P, Dorman E, Olagbaiye F, Akinfenwa O. A case report of spontaneous splenic capsular rupture associated with atypical presentation of haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. J Obstet Gynaecol. 2004;24(3):317–8. Bljajic D, Ivanisevic M, Djelmis J, Majerovic M, Starcevic V. Splenic rupture in pregnancy–traumatic or spontaneous event? Eur J Obstet Gynecol Reprod Biol. 2004;115(1):113–4. Popli K, Chitra R, Puri M. Spontaneous rupture of spleen in term pregnancy. Trop Doct. 2004;34(1):54–5. Hamedi B, Shomali Z. Postpartum Spontaneous Rupture of Spleen in a Woman with Severe Preeclampsia: Case Report and Review of the Literature. Bull Emerg Trauma. 2013;1(1):46–8. Additional Declarations No competing interests reported. Supplementary Files PRISMA2020checklist.docx Cite Share Download PDF Status: Published Journal Publication published 29 Nov, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 29 Oct, 2025 Reviewers agreed at journal 28 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviews received at journal 27 Oct, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviews received at journal 26 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 09 Oct, 2025 Editor assigned by journal 07 Oct, 2025 Editor invited by journal 11 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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19:31:42","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":61672,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7522469/v1/24b247ec0e8cc66300463958.html"},{"id":94139163,"identity":"0d77ac35-658e-4d23-afb9-d27f944b96cb","added_by":"auto","created_at":"2025-10-22 19:31:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":494731,"visible":true,"origin":"","legend":"\u003cp\u003eParaffin-embedded histological section of resected spleen tissue\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7522469/v1/3361b5d81ec36f84a9ec21ad.png"},{"id":94139169,"identity":"3ad37998-8a07-4cc9-a86b-5e82fb2af3ec","added_by":"auto","created_at":"2025-10-22 19:31:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55272,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA scheme: literature review on splenic rupture and pregnancy\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7522469/v1/46fb654c8f97f95ec13b4a7e.png"},{"id":97178749,"identity":"00ad8da7-5770-4cfb-8700-3d5f7a13d6ac","added_by":"auto","created_at":"2025-12-01 16:13:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1147328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7522469/v1/82333543-55ca-4fdf-bc7f-30215d673f48.pdf"},{"id":94139165,"identity":"d183a080-44af-4e01-a3b4-d9ba76789547","added_by":"auto","created_at":"2025-10-22 19:31:42","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":668986,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2020checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7522469/v1/81afa3fad73e0f30909f8161.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review","fulltext":[{"header":"Background","content":"\u003cp\u003eAt present, antepartum, intrapartum, and postpartum haemorrhage represents one of the primary causes of maternal mortality on a global scale[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Within the paradigm of optimal splenic function during pregnancy, the spontaneous or non-traumatic occurrence of splenic rupture is an exceptionally uncommon occurrence[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is defined as occurring in the absence of any concomitant splenic injury, systemic disease, trauma, or evidence of splenic adhesions[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A major challenge in diagnosing this condition is the absence of specific symptoms during this delicate phase of development, potentially resulting in delayed diagnoses and adverse outcomes[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Splenic rupture, which can result in fatal injuries, is a potentially life-threatening complication that can occur in any type of trauma, with or without identifiable precipitating factors. Nevertheless, it must be noted that in certain cases, the mechanisms and causes of injury are multifactorial in nature and remain unclear. It has been posited by preceding writers that gestation itself can act as a risk factor for splenic rupture. This phenomenon is believed to be attributable to a combination of factors, chief among them being hypotension and variations in the positioning of abdominal organs.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eThis case study focuses on a 33-year-old pregnant woman who conceives naturally at a suitable age. The patient has a regular menstrual cycle, with her last menstrual period occurring on 30 December 2024. The estimated gestational age is 27 weeks and 2 days. The patient was referred from a lower-level medical facility, having experienced a one-day history of abdominal discomfort. This is the subject's first pregnancy. There is no record of any significant illnesses, surgery or trauma. It is evident that the patient has participated in scheduled antenatal consultations throughout the gestational period, with all assessments conducted in a consistent and satisfactory manner. The patient's height was recorded at 164 cm, and a weight of 65.5 kg was determined, indicating a fair nutritional status. A routine ultrasound scan conducted one week prior revealed polyhydramnios (amniotic fluid depth 8.2 cm, amniotic fluid index 26.9), although the patient reported no subjective symptoms. On the day of the presentation, abdominal distension and pain were observed at 7:00 am following defecation. Following the occurrence of a second bowel movement at 10:00 am, there was an improvement in the symptoms. There was a recurrence of intense abdominal pain at 12:00am, which necessitated presentation at a local hospital. In view of the findings of the antenatal ultrasound, which revealed a left adnexal cyst measuring 2.5 \u0026times; 1.7 cm, the local hospital diagnosed ovarian cyst torsion, with the possibility of rupture. Treatment with magnesium sulphate and anti-inflammatory agents did not result in a significant improvement. A subsequent ultrasound examination that evening revealed the presence of 5 cm of abdominal fluid, in addition to persistent, diffuse abdominal pain. This prompted the patient to be transferred to our hospital. Upon admission, the patient exhibited stable vital signs, with blood pressure recorded at 100/70 mmHg and a pulse rate of 70 beats per minute. The fundal height was measured at 31 cm; however, assessment of the abdominal circumference was not possible due to the patient's inability to cooperate. The patient reported no history of trauma. A physical examination was conducted, which revealed tenderness throughout the abdomen, most pronounced in the upper abdomen. Positive signs of peritoneal irritation were also observed. The uterus exhibited signs of tension, but no discernible contractions were observed. No vaginal bleeding was observed, and the foetal heart rate was found to be within the normal range.\u003c/p\u003e\u003cp\u003eThe patient attended the emergency department that evening with a hemoglobin level of 81 g/dl. Emergency abdominal ultrasound revealed maternal abdominal fluid accumulation, with the deepest pocket located in the left abdominal cavity at approximately 7.7 cm depth, containing scattered flocculent echoes. Furthermore, the presence of fluid was observed in the prehepatic space at a depth of approximately 2.1 cm, as well as in the hepatorenal space at a depth of approximately 1.9 cm. The mean fetal heart rate was approximately 128 beats per minute, and the umbilical artery S/D ratio was 4.1. The amniotic fluid depth was measured at approximately 11.1 cm, and the amniotic fluid index was recorded at 34 cm. A whole abdominal plain CT scan revealed pelvic and abdominal fluid accumulation; no other significant abnormalities were noted. The patient was urgently admitted to the ward for close monitoring. During the monitoring period, vital signs remained stable. However, subsequent biochemical analyses revealed a progressive decline in hemoglobin levels (02:21 78 g/dl, 04:56 72 g/dl, 08:21 71 g/dl). A subsequent ultrasound examination the following morning revealed the persistence of abdominal fluid, with a depth of approximately 7.0 cm. The foetal umbilical artery S/D ratio increased to 5.3, with a fetal heart rate of approximately 140 beats per minute. In view of the progressive hemoglobin decline, intra-abdominal haemorrhage and suspected foetal distress could not be ruled out. The patient's heart rate had increased to 120\u0026ndash;130 beats per minute, with blood pressure measuring between 100\u0026ndash;120/70\u0026ndash;80 mmHg. Following a series of detailed explanations regarding the condition, the patient and her family indicated their desire to terminate the pregnancy. The patient underwent an emergency caesarean section, which was performed in conjunction with an exploratory laparotomy. A caesarean section was performed on the lower segment of the uterus. The amniotic fluid was found to be clear. A male infant with a birth weight of 1230g was delivered by caesarean section. Following resuscitation by the obstetrician-gynecologist during delivery, the APGAR scores were 5/1 minute and 10/5 minutes. The infant was subsequently transferred to the neonatal ward for inpatient treatment. The patient demonstrated laxity and weakness across all layers of the abdominal wall, with a thin muscular layer. Upon entering the abdominal cavity, approximately 2000 ml of free blood with clots was observed, alongside extensive clots in the upper abdomen and perih\u0026eacute;patic region. Intraoperative examination of the uterus revealed no localized haemorrhage or rupture, with no evidence of placental abruption or uterine rupture. A thorough examination of the adnexa revealed the presence of a 3\u0026times;3 cm chocolate cyst on the left ovary and a 1\u0026times;1 cm cyst on the left fallopian tube. The absence of any indications of torsion or rupture was noted, and both were completely excised during the surgical procedure. Subsequently, the surgeon extended the abdominal incision vertically around the umbilicus to approximately 30 cm in length, thus enabling exploration of the upper and middle abdominal cavities. Active bleeding was observed on the greater omentum in the proximity of the splenic hilum along the greater curvature of the stomach. A rupture was identified in the splenic capsule at the hilum, accompanied by adjacent adhesions on the greater omentum. This was interpreted as splenic rupture caused by traction from omental adhesions, necessitating splenectomy. The surgical procedure was conducted without incident, resulting in approximately 300 ml of intraoperative blood loss. This necessitated the transfusion of two units of packed red blood cells. Postoperatively, the patient was transferred to the intensive care unit for further management. Following a period of two days involving intensive care, the patient's condition stabilized. She was subsequently discharged from the obstetrics ward and discharged home after six days. Subsequent postoperative paraffin-embedded histopathological examination (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) confirmed the presence of splenic rupture. Beyond the hematoma resulting from this rupture, no other pathologies such as splenic artery aneurysms were identified histologically. The infant is currently undergoing treatment in the neonatal intensive care unit. At the time of writing, no sequelae have been reported.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cb\u003eLiterature review\u003c/b\u003e The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram was used for the literature review. In September 2025, a systematic search was conducted in the MedLine, Embase, and Cochrane Library databases without any date restrictions. A review of the published literature was conducted using the keywords 'splenic rupture' and 'pregnancy' in the MedLine, Embase, and Cochrane Library databases. A secondary reference review of these publications was also conducted to identify any additional relevant articles and case reports. The databases used for the literature review and the results obtained are listed below. EndNote was used for reference management and duplicate detection.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePRISMA diagram\u003c/b\u003e The search included the MEDLINE (n\u0026thinsp;=\u0026thinsp;505), Embase(n\u0026thinsp;=\u0026thinsp;544), and Cochrane Library databases. A total of 504 references were removed, with 493 duplicates identified manually excluded. The number of studies screened was 556, of which 479 were excluded. The number of studies sought for retrieval was 77. The number of studies assessed for eligibility was 77, of which 67 were excluded. As a result, the number of studies included in the review was 10 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe pregnant woman was diagnosed as spontaneous splenic rupture\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSpontaneous splenic rupture occurs before delivery.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe literature was published between 1995 and 2025.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003ePatients with history of trauma or disease.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion and literature review","content":"\u003cp\u003eThe spontaneous rupture of the normal spleen in the absence of a history of trauma is an extremely rare clinical event. As presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a number of previous case reports were identified which exhibited a comparable presentation to that of the present case, and which were diagnosed with prenatal splenic rupture during pregnancy from 1995 to 2025.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePast studies reporting cases of prenatal spontaneous splenic rupture\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor and country\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eyear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge, and parity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGestational\u003c/p\u003e\u003cp\u003eAge (Weeks)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRadiological or Clinical Findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eXu China[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25, G1P0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eabdominal pain and fetal bradycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYakub R, UK[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37, G2P1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39\u0026thinsp;+\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003etachycardic\u003c/p\u003e\u003cp\u003eand hypotensive, A Focused Assessment with\u003c/p\u003e\u003cp\u003eSonography in Trauma (FAST) scan suggested free fluid in the\u003c/p\u003e\u003cp\u003eabdomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdil Elghanmi, Morocco[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26, G2P1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eupper abdominal pain, vertigo and general weakness\u003c/p\u003e\u003cp\u003eat home, Ultrasonographic exam revealed\u003c/p\u003e\u003cp\u003ean extensive intra-abdominal\u003c/p\u003e\u003cp\u003efluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and fetus died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWang Cecina[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30, G1P0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eacute hypotension\u003c/p\u003e\u003cp\u003eand tachycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother survived and fetus died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDi Vella et al., Italy[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28, G3P2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ehemorrhagic shock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother died, infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTuran et al., Turkey[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28, G2P1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eadmitted to the hospital dead after collapsing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTracheostomy and cardiopulmonary\u003c/p\u003e\u003cp\u003eresuscitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and fetus died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRiches et al., Israel[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32, G4P3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003efetal bradycardia, a diffusely\u003c/p\u003e\u003cp\u003etender and distended abdomen, with signs of peritoneal\u003c/p\u003e\u003cp\u003eirritation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManda et al., UK[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30, G3P2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003efetal compromise, Ultrasonography confirmed an intraperitoneal fluid collection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBajic et al., Croatia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38, G༟P༟\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ehaemorrhagic\u003c/p\u003e\u003cp\u003eshock and increasing abdominal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopli et al., India[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20, G2P1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHypotension,\u003c/p\u003e\u003cp\u003eintraabdominal\u003c/p\u003e\u003cp\u003ebleeding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother survived, infant died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent case\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33, G1P0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u0026thinsp;+\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHemoglobin decreasing, Ultrasonography confirmed intra-abdominal\u003c/p\u003e\u003cp\u003efluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCesarean delivery and splenectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMother and infant survived\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSpontaneous splenic rupture during pregnancy is an exceptionally rare clinical occurrence. The term \"spontaneous rupture of a normal spleen\" refers to the occurrence of rupture without the presence of prior trauma[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. During exploration, the splenic parenchyma, vascular system, and capsule should appear macroscopically and histologically normal. The etiology of spontaneous rupture of a normal spleen during pregnancy remains inconclusive. It has been hypothesized that splenic enlargement during pregnancy, increased blood volume, and reduced peritoneal cavity space may be implicated in the pathogenesis of rupture[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The presence of circulating hormones, such as estrogen and progesterone, has been demonstrated to induce structural alterations in the spleen[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This has been shown to potentially elevate the risk of splenic rupture during pregnancy, even in cases of minor trauma[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSpontaneous splenic rupture, although rare, is typically observed in cases occurring during the late gestational period and the postpartum phase[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, spontaneous splenic rupture in mid-pregnancy, as in the case we report, is even more uncommon. As gestational age increases, the uterus, which is responsible for the gestation of the foetus, exerts an upward pressure on the abdominal organs, thereby altering their physiological positioning compared to that observed in non-pregnant individuals[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. By the final trimester, the pressure exerted by the uterus on the abdominal structures has reached its zenith. In this particular instance, the patient exhibited polyhydramnios one week prior to presentation, accompanied by rapid fundal height increase and signs of uterine hypertonicity. This finding suggests that, despite being in the mid-pregnancy stage, the patient's uterine enlargement was significantly pronounced. Consequently, compression occurred at the greater curvature of the stomach and the adjacent greater omentum, causing them to adhere to neighboring organs. In instances where the patient experienced discomfort during defecation, this resulted in an increase in intra-abdominal pressure. Consequently, traction was exerted on the splenic hilum, leading to localized rupture. This resulted in haemorrhage and subsequent shock, representing the probable mechanism for the spontaneous splenic rupture observed in this case. This emphasizes the necessity for increased vigilance in pregnant women with polyhydramnios, irrespective of gestational age, necessitating a comprehensive evaluation for acute abdominal conditions when abdominal pain manifests.\u003c/p\u003e\u003cp\u003eThe diagnosis of splenic rupture during pregnancy is challenging due to the similarity of its signs and symptoms to those of other common obstetric acute abdominal emergencies, such as uterine rupture and placental abruption[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The classic presentation of spontaneous splenic rupture is characterized by the presence of free abdominal haemorrhage, including symptoms such as abdominal pain, haemorrhagic shock and decreased hemoglobin levels. In the cases that have been documented, a number of patients who have experienced spontaneous splenic rupture have presented primarily with sudden syncope in the home environment[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The challenge of timely recognition and management of splenic rupture during pregnancy results in high rates of maternal and foetal mortality. The predominant cause of maternal death is typically massive haemorrhage, accompanied by haemorrhagic shock and consumptive coagulopathy. Acute maternal haemorrhage leads to a sudden reduction in uteroplacental perfusion, causing foetal distress and ultimately foetal death.\u003c/p\u003e\u003cp\u003eFortunately, in this case, the patient underwent a caesarean section and splenectomy in a timely manner. The mother exhibited a positive recovery trajectory and was subsequently discharged from the hospital. The foetus, meanwhile, received prompt treatment in the paediatric department. This marks the earliest recorded gestational age of foetal survival following spontaneous splenic rupture.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case report concerns a case of spontaneous splenic rupture in a female patient with polyhydramnios during the mid-pregnancy period. This represents the earliest gestational age of foetal survival following spontaneous splenic rupture reported worldwide to date. The patient presented with upper abdominal pain and intra-abdominal haemorrhage, with no history of trauma. The patient exhibited rapid, progressive hemoglobin decline, haemorrhagic shock, and foetal distress. Consequently, an emergency caesarean section and exploratory laparotomy were performed, followed by prompt total splenectomy upon confirmation of the diagnosis. The expeditious clinical recognition, diagnosis, and timely surgical intervention are of paramount importance for the effective management of this condition and the determination of prognosis. The splenectomy and subsequent histopathological examination revealed no evidence of malignancy or other pathologies, thus confirming the diagnosis of spontaneous splenic rupture. This case underscores the importance of investigating acute abdominal emergencies during pregnancy, even in the absence of trauma or precipitating factors. Clinicians should remain vigilant for this uncommon complication and consider it within the framework of a differential diagnosis, thereby ensuring expeditious and efficacious management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eWritten consent was obtained from the patient to participate. According with The\u003c/p\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003e Written informed consent for publication was obtained from the patient.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYilin Meng conceptualized the study, designed the case - report structure, and led the literature review, integrating case details with findings for a coherent narrative. She ensured high scientific and clinical standards.Xuan Zhang analyzed the case, collected and organized patient data, contributed to the clinical implications section, and assisted in statistical analysis. She also participated in drafting and revising the manuscript.Both authors approved the final version and are accountable for the work's integrity.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank the patient and her family for consenting to publish this case report.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets analyzed during the current study are not publicly available dueto protection of the patient\u0026rsquo;s privacy but are available from the correspondingauthor on reasonable request (email: [email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSharma C, Patel H. Spontaneous Splenic Rupture Following Vaginal Delivery in Severe Preeclampsia: A Case Report. Cureus. 2023;15(12):e50266.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed RA, Yaseen FA, Aljudaibi RS, Ahmed NA. A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia. Cureus. 2024;16(4):e58246.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLondero F, Cociancich G. Spontaneous rupture of the spleen in labor. Am J Obstet Gynecol. 2000;183(3):782\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang C, Tu X, Li S, Luo G, Norwitz ER. Spontaneous rupture of the spleen: a rare but serious case of acute abdominal pain in pregnancy. J Emerg Med. 2011;41(5):503\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrloff MJ, Peskin GW. Spontaneous rupture of the normal spleen; a surgical enigma. Int Abstr Surg. 1958;106(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKorkontzelos I, Kyrochristou G, Stefanou S, Spyropoulou K, Mpourazanis G, Theodorou DJ, Papanikolaou A, Korkontzelou PD, Georgakopoulou VE, Papalexis P. Splenic Rupture in an Elective Cesarean Section: A Possible Iatrogenic Event. Cureus. 2023;15(11):e48478.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu H, Lu JP. Spontaneous rupture of the spleen at full term during pregnancy: a case report. J Int Med Res. 2023;51(9):3000605231196818.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYakub R, Ahmad G, Rana N, Titi S. A rare case of 'spontaneous' splenic rupture in pregnancy: A successful outcome for mother and baby against the odds. J Obstet Gynaecol. 2017;37(3):385\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElghanmi A, Mohamed J, Khabouz S. Spontaneous splenic rupture in pregnancy. Pan Afr Med J. 2015;21:312.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDi Vella G, Arpaio A, Marzullo A, Colonna M. Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases. Forensic Sci Int. 2008;176(2\u0026ndash;3):e1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTuran N, Oghan F, Boran T. Spontaneous rupture of splenic vein in a pregnant woman during a religious ritual. J Forensic Leg Med. 2007;14(7):440\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReches A, Almog R, Pauzner D, Almog B, Levin I. Spontaneous splenic rupture in pregnancy after heparin treatment. BJOG. 2005;112(6):837\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManda P, Dorman E, Olagbaiye F, Akinfenwa O. A case report of spontaneous splenic capsular rupture associated with atypical presentation of haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. J Obstet Gynaecol. 2004;24(3):317\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBljajic D, Ivanisevic M, Djelmis J, Majerovic M, Starcevic V. Splenic rupture in pregnancy\u0026ndash;traumatic or spontaneous event? Eur J Obstet Gynecol Reprod Biol. 2004;115(1):113\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePopli K, Chitra R, Puri M. Spontaneous rupture of spleen in term pregnancy. Trop Doct. 2004;34(1):54\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamedi B, Shomali Z. Postpartum Spontaneous Rupture of Spleen in a Woman with Severe Preeclampsia: Case Report and Review of the Literature. Bull Emerg Trauma. 2013;1(1):46\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7522469/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7522469/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSpontaneous rupture of the spleen during pregnancy or after Delivery is an extremely rare, harmful and life-threatening complication that poses a major challenge to diagnosis and treatment. It also reviews the relevant literature to discuss the characteristics of patients with prenatal spontaneous splenic rupture.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e\u003cp\u003eA 33-year-old woman with spontaneous splenic rupture at 27 weeks of gestation is presented here in a case study. Despite the absence of a history of trauma and recognized risk factors, the patient exhibited symptoms of polyhydramnios accompanied by abdominal distension one week prior. One week later, the patient presented to the emergency department. They had an abdominal ultrasound. This revealed a large amount of ascites. This was not seen on a whole abdominal CT. This was to identify the location of bleeding. The patient also had a progressive decline in hemoglobin. There was also abnormal fetal umbilical artery blood flow. After a multidisciplinary consultation, emergency c-section and exploratory laparotomy were performed. The departments involved were surgery, gynecology, obstetrics, ultrasound, radiology and neonatology. After delivery of the fetus, exploration revealed an active haemorrhage. This was near the splenic hilum on the greater omentum. There was also a ruptured capsule at the splenic hilum. Following consultation with the surgeon and with the family's consent, a complete splenectomy was performed. The diagnosis of spontaneous splenic rupture was confirmed by postoperative paraffin-embedded pathology. This is a very rare case. Excessive amniotic fluid, increased abdominal pressure and rupture of the greater omentum and splenic capsule after omental traction are the current causes for concern. These result in intraperitoneal haemorrhage and haemorrhagic shock.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis case emphasizes the importance of monitoring amniotic fluid volume during pregnancy closely, as well as the early monitoring, diagnosis and treatment of acute abdomen induced by polyhydramnios. Active surgical intervention will help to improve maternal outcomes and prognosis.\u003c/p\u003e","manuscriptTitle":"Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:31:37","doi":"10.21203/rs.3.rs-7522469/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-29T14:44:07+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"277890538393842898652546222192622481770","date":"2025-10-29T02:50:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T03:21:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178375760534310447679582879799063215677","date":"2025-10-28T03:16:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15546582671708734103227359287961801769","date":"2025-10-28T03:01:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277877898080115926971488428255519274114","date":"2025-10-27T21:59:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T11:29:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179702646239998732603853672658954019157","date":"2025-10-27T10:20:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285671076939001304822234561317551773373","date":"2025-10-26T12:47:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T09:18:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275659768959128788071242700307783450586","date":"2025-10-26T09:10:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T12:45:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58162793088039683453603870635788202582","date":"2025-10-09T23:25:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T16:50:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181841924228150965527853423486538560416","date":"2025-10-09T16:30:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T09:10:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T03:19:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T09:14:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T08:46:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-09T08:43:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8074b17-2e8a-417b-bce1-81f95b3e0800","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:06:32+00:00","versionOfRecord":{"articleIdentity":"rs-7522469","link":"https://doi.org/10.1186/s12884-025-08532-w","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-11-29 15:57:12","publishedOnDateReadable":"November 29th, 2025"},"versionCreatedAt":"2025-10-22 19:31:37","video":"","vorDoi":"10.1186/s12884-025-08532-w","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08532-w","workflowStages":[]},"version":"v1","identity":"rs-7522469","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7522469","identity":"rs-7522469","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}