SPONTANEOUS HEMOPERITONEUM DURING LABOUR - A RARE CASE REPORT

Spontaneous rupture of utero-ovarian vessels is a potentially lethal complication of pregnancy. There has been only about 150 cases reported in the literature . Spontaneous hemoperitoneum may develop from rupture of various abdominal or pelvic viscera like spleen, liver and also uterus, from the utero- ovarian vessels and rarely from pelvic endometrial implants. Here we report a case of 27 yr old primigravida at 39weeks and 2 days gestation with gestational hypertension who was admitted for safe confinement. Labour was induced in view of elevated blood pressure. Patient developed sudden hypotension and tachycardia in the second stage of labour. Since the pervaginal examination at that time showed a fully dilated cervix with the vertex at plus 2 station vaccum was applied and a live male baby weighing 3 kgs was delivered vaginally. Bleeding was within normal limits but her blood pressure failed to rise inspite of adequate IV fluids. USG abdomen done showed frank hemoperitoneum. Emergency laparotomy was done a profusely bleeding vessel from the posterior wall of the uterus was identified and the same was ligated. This case has been reported for its extreme rarity. The etiology of spontaneous rupture of utero-ovarian vessels during pregnancy remains poorly understood. However, several etiologic hypothesis have been postulated, based on the previously reported cases like arteriovenous malformations, uterine artery aneurysm, endometriosis, increase in venous pressure (especially during labour), free anastomosis of uterine and ovarian vessels within broad ligament, absence of valves in ovarian veins and weakness of the vessels. Differential diagnosis may include placental abruption, uterine rupture, abdominal pregnancy, spontaneous rupture of maternal umbilical vein or aneurysmal vessels, rupture of liver or spleen or their vasculature, appendix rupture and HELLP syndrome .The diagnosis of this condition is usually made only during laparotomy.