Spontaneous Rupture of Uterine Vessels Complicated with Placental Abruption: A Rare Case Report.

PURPOSE: Untreated spontaneous hemoperitoneum in pregnancy (SHiP) can be fatal. It is a rare disorder that occurs during pregnancy. SHiP is associated with a reported maternal mortality rate of 1.7% and a perinatal mortality rate of 26.9%. In SHiP, several etiologies have been reported, which vary depending on the gestational age. Uterine vein rupture is one of these causes. We present a rare case of a 23-year-old Sundanese primigravid woman at 33-34 weeks of gestation who presented with fetal distress and retroplacental bleeding, suggesting placental abruption, which was confirmed by intraoperative findings. CASE PRESENTATION: A 23-year-old Sundanese primigravid woman presented to Waled General District Hospital, Cirebon, West Java, Indonesia, with sudden abdominal pain along with abdominal tension 14 hours before admission. Labor pain was also constantly felt at regular intervals for 12 hours before admission. Physical examination was unremarkable, except for tachycardia, which was noted at 140 bpm. Cardiotocography revealed fetal distress. Ultrasound findings revealed a retroplacental hematoma due to placental abruption. An emergency caesarean section was performed because of fetal distress. Intraoperatively, approximately 1000 cc of intra-abdominal bleeding was found, originating from the rupture of the uterine venous plexus, confirming the diagnosis of spontaneous hemoperitoneum in pregnancy (SHiP). Uterine fibroids were observed in the left fundal uterus. The patient received three units of packed red cell (PRC) transfusion along with an IV fluid loading dose and two units of fresh frozen plasma (FFP). Both the patient and the baby were discharged under stable conditions. CONCLUSION: Spontaneous hemoperitoneum in pregnancy (SHiP) due to rupture of the uterine venous plexus is rare but may lead to life-threatening circumstances. These conditions may occur alongside placental abruption and manifest as fetal distress, requiring comprehensive analysis and prompt surgical intervention despite the lack of maternal hypotension and trauma.