Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review
Abstract Background Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complicati...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00498-w |
| _version_ | 1797578324864663552 |
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| author | Anh Dinh Bao Vuong Thanh Hai Pham Xuan Trang Nguyen Ngoc Bich Trinh Phuc Nhon Nguyen Quang Nhat Ho |
| author_facet | Anh Dinh Bao Vuong Thanh Hai Pham Xuan Trang Nguyen Ngoc Bich Trinh Phuc Nhon Nguyen Quang Nhat Ho |
| author_sort | Anh Dinh Bao Vuong |
| collection | DOAJ |
| description | Abstract Background Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively. Case presentation The pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient’s history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later. Conclusions In pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate. |
| first_indexed | 2024-03-10T22:21:14Z |
| format | Article |
| id | doaj.art-5678f9bd96844bd7815b3f278bdda998 |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-03-10T22:21:14Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-5678f9bd96844bd7815b3f278bdda9982023-11-19T12:16:38ZengBMCInternational Journal of Emergency Medicine1865-13802023-04-0116111010.1186/s12245-023-00498-wSpontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature reviewAnh Dinh Bao Vuong0Thanh Hai Pham1Xuan Trang Nguyen2Ngoc Bich Trinh3Phuc Nhon Nguyen4Quang Nhat Ho5Department of High-Risk Pregnancy, Tu Du HospitalTu Du Clinical Research Unit (TD-CRU)Department of High-Risk Pregnancy, Tu Du HospitalDepartment of High-Risk Pregnancy, Tu Du HospitalDepartment of High-Risk Pregnancy, Tu Du HospitalDepartment of Postoperative Care, Block A, Tu Du HospitalAbstract Background Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively. Case presentation The pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient’s history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later. Conclusions In pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate.https://doi.org/10.1186/s12245-023-00498-wEmergencyHemoglobinMaternal mortalityPregnancyFetal deathSpontaneous hemoperitoneum |
| spellingShingle | Anh Dinh Bao Vuong Thanh Hai Pham Xuan Trang Nguyen Ngoc Bich Trinh Phuc Nhon Nguyen Quang Nhat Ho Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review International Journal of Emergency Medicine Emergency Hemoglobin Maternal mortality Pregnancy Fetal death Spontaneous hemoperitoneum |
| title | Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review |
| title_full | Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review |
| title_fullStr | Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review |
| title_full_unstemmed | Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review |
| title_short | Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review |
| title_sort | spontaneous hemoperitoneum in the second and third trimester of pregnancy two uncommon case reports at tu du hospital in vietnam and a literature review |
| topic | Emergency Hemoglobin Maternal mortality Pregnancy Fetal death Spontaneous hemoperitoneum |
| url | https://doi.org/10.1186/s12245-023-00498-w |
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