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Hu L, Ning J, Li L, Lu Y, You Y. Two cases of spontaneous rupture of the uterine artery in the perinatal period: A case report. Medicine (Baltimore) 2023; 102:e33692. [PMID: 37335718 DOI: 10.1097/md.0000000000033692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE Uterine artery spontaneous rupture is a rare but potentially life-threatening complication during pregnancy and puerperium. The lack of typical symptoms makes it difficult to diagnose, which can result in serious consequences for both the mother and fetus. PATIENT CONCERNS Case 1 presented with fainting and lower abdominal discomfort, while Case 2 developed hypotension after delivery and remained in poor condition even after rehydration. DIAGNOSES Both cases were diagnosed with uterine artery spontaneous rupture, with intraoperative findings revealing ruptures in different branches of the uterine artery. INTERVENTIONS Both cases underwent surgical interventions, with laparoscopic surgery performed in Case 1 and repair of the ruptured artery in Case 2. OUTCOMES Both cases had successful outcomes, with the ruptured arteries repaired and the patients discharged from the hospital within a week after surgery. LESSONS Uterine artery spontaneous rupture is a rare but potentially life-threatening complication that may present with atypical symptoms. Early diagnosis and prompt surgical intervention are crucial in preventing serious complications for both the mother and fetus. Clinicians should maintain a high level of suspicion for this condition when evaluating patients presenting with unexplained symptoms or signs of peritoneal irritation during pregnancy and puerperium.
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Affiliation(s)
- Lingyun Hu
- Department of Obstetrics & Gynecology, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Jing Ning
- Department of Obstetrics & Gynecology, Sanya Maternal and Child Health Hospital, Sanya, Hainan, China
| | - Li'an Li
- Department of Obstetrics & Gynecology, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Yanping Lu
- Department of Obstetrics & Gynecology, The First Medical Center of the PLA General Hospital, Beijing, China
| | - Yanqin You
- Department of Obstetrics & Gynecology, The First Medical Center of the PLA General Hospital, Beijing, China
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Ruan J, Zhao G. Spontaneous uterine venous plexus complicated with ovarian rupture in the third trimester of pregnancy: a case report. BMC Pregnancy Childbirth 2023; 23:250. [PMID: 37055719 PMCID: PMC10100169 DOI: 10.1186/s12884-023-05556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Spontaneous uterine venous rupture combined with ovarian rupture in late pregnancy is extremely rare. It often has an insidious onset and atypical symptoms, develops rapidly, and is easily misdiagnosed. Wewould like to discuss and share this case of spontaneous uterine venous plexus combined with ovarian rupture in the third trimester of pregnancy with colleagues. CASE PRESENTATION A pregnant woman, G1P0 at 33+4 weeks of gestation,was admitted to the hospital due to threatened preterm labour on March 3, 2022. After admission, she was treated with tocolytic inhibitors and foetal lung maturation agents. The patient's symptoms did not improve during the treatment. After many examinations, tests, discussions, a diagnosis, and a caesarean section, the patient was finally diagnosed with atypical pregnancy complicated by spontaneous uterine venous plexus and ovarian rupture. CONCLUSIONS Spontaneous rupture of the uterine venous plexus combined with ovarian rupture in late pregnancy is an occult and easily misdiagnosed condition, and the consequences are serious. Clinical attention should be given to the disease and prevention attempted to avoid adverse pregnancy outcomes.
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Affiliation(s)
- Jiming Ruan
- Department of Obstetrics and Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, 313000, China
| | - Gang Zhao
- Department of Obstetrics and Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, 313000, China.
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Muacevic A, Adler JR, Almeida M, Canelas L. Endometriosis-Related Spontaneous Hemoperitoneum in the Third Trimester: A Case Report. Cureus 2022; 14:e32897. [PMID: 36699776 PMCID: PMC9869646 DOI: 10.7759/cureus.32897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but significant condition in pregnancy and is linked to high rates of morbidity and mortality. Endometriosis increases the risk of SHiP, particularly during the third trimester of pregnancy. We report a case of a 45-year-old woman in the third trimester of a pregnancy complicated by SHiP due to the rupture of a uterine artery by an endometriosis implant, which is a particularly rare cause.
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Golfier F, Pleynet L, Bolze PA. Spontaneous hemoperitoneum in pregnancy: a life-threatening maternal and fetal complication of endometriosis. J Gynecol Obstet Hum Reprod 2022; 51:102415. [PMID: 35667589 DOI: 10.1016/j.jogoh.2022.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/28/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spontaneous hemoperitoneum in pregnancy (SHiP) is a complication of endometriosis. We describe the clinical characteristics and outcomes of mother and fetus in 11 new cases of SHiP with endometriosis and 43 cases reported in the literature since 1995. MATERIAL AND METHODS The 60 maternity hospitals in the Auvergne-Rhône-Alpes region in France were contacted to identify cases of SHiP associated with endometriosis. . In parallel, a systematic review of the literature used the PRISMA chart to report published cases. RESULTS Fifty-four cases of SHIP associated with endometriosis are presented. Twenty-four patients (44%) conceived with assisted reproductive techniques. Hemoperitoneum occurred before delivery in 47/54 cases (87%).The average gestational age of occurrence was 27 weeks (13 weeks to 40+6 weeks). An hypovolemic shock was present in 24/51 (47%) of patients. Forty-six women (85%) were treated by laparotomy, 5 (9%) by laparoscopy, 2 (2%) by interventional radiology. The hemorrhage site was in the mediolateral compartment of the pelvis in 29 cases (54%), corresponding to bleeding from vessels in the broad ligament in 24/29 (83%) of these cases. The mean estimated blood loss was 1957 mL (150-7500 mL). Emergency peripartum hysterectomy was required in 3/54 cases (6%). There were no maternal deaths. The average gestational age at birth was 30 weeks (13+2 weeks to 42 weeks). The fetus died in 19/64 cases (30%). CONCLUSION SHiP is an underestimated potentially fatal complication of endometriosis. Maternal salvage by emergency laparotomy is usually required to identify and treat the bleeding site. Fetal prognosis remains poor.
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Affiliation(s)
- François Golfier
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalo-universitaire de Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Léa Pleynet
- Faculté de médecine et de maïeutique Lyon Sud - Charles Mérieux. Université Claude Bernard-Lyon 1
| | - Pierre-Adrien Bolze
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalo-universitaire de Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
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Kollikonda S, Chavan M. Endometriosis Scarring-A Potential Etiology for Spontaneous Hemoperitoneum in Pregnancy. J Obstet Gynaecol Can 2021; 43:998-1000. [PMID: 33798766 DOI: 10.1016/j.jogc.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endometriosis is a common condition characterized by the accumulation of dense adhesions and scar tissue around the pelvic organs, which can lead to complications. Disruption of endometriotic scar tissue is rare but can lead to spontaneous intraperitoneal hemorrhage in pregnancy. CASE We present the case of a patient admitted for signs of labour at 40 weeks gestation. At emergency cesarean delivery for cord prolapse, the patient was found to have a massive intraperitoneal bleed. Mechanical disruption of endometriotic scar tissue during positioning for an epidural may have been the precipitating event, as the symptoms of spontaneous hemorrhage, including hypotension and pain, appeared immediately afterward. CONCLUSION Without the cord prolapse, cesarean delivery would have been delayed and the spontaneous hemorrhage might have been missed. This case report alerts obstetricians to have a high index of suspicion for spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis, as this event can be life-threatening to mother and baby.
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Huang LY, Hsu PY, Chiang CT, Chen HW, Wu MH. Endometriosis-related spontaneous hemoperitoneum in the early second trimester: A case report. Taiwan J Obstet Gynecol 2021; 60:328-30. [PMID: 33678336 DOI: 10.1016/j.tjog.2021.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To present a rare case of endometriosis-related spontaneous hemoperitoneum in pregnancy (SHiP) with atypical subacute symptoms, which is likely to be mistaken as an infectious disease initially. CASE REPORT A 35-year-old primigravid woman presented with diffuse lower abdominal pain and signs of peritoneal irritation for five days at 18 weeks' gestation, and the initial diagnosis was acute peritonitis. An abrupt deterioration with maternal shock and stillbirth of fetus was found in spite of close observation in emergent department. Emergent laparotomy was performed for delay-appeared hemoperitoneum. Bleeding from decidualized endometriotic tissue over posterior uterine surface was found, and hemostasis was achieved with uterine preservation. The patient recovered smoothly. CONCLUSION SHiP is a serious obstetric complication of endometriosis with diagnostic difficulty. Its initial presentation may mimic infectious disease, so close monitoring for possible abrupt deterioration is crucial. Early detection and timely management are the key to avoid adverse pregnancy outcomes.
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Kumari J, Harkin R. Abdominal apoplexy during pregnancy. BMJ Case Rep 2020; 13:13/10/e235946. [PMID: 33127691 DOI: 10.1136/bcr-2020-235946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. 'Abdominal apoplexy' (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
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Affiliation(s)
- Jasmeet Kumari
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
| | - Rosemary Harkin
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
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Abstract
BACKGROUND Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy. In this article, we report 4 cases of intra-abdominal hemorrhage during pregnancy, including the spontaneous rupture of uterine veins, spontaneous rupture of liver, rupture of external iliac vessel branch, and rupture of right renal hamartoma.
CASE SUMMARY The clinical manifestations of three patients lacked specificity, and the localization of the bleeding was not clear prior to surgery. All 4 pregnant women were successfully treated, while only one full-term infant survived.
CONCLUSION There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic, and it is clinically characterized by acute abdominal pain during pregnancy. Clear diagnosis before surgery is rather difficult. Early diagnosis, timely and appropriate treatment and surgery, and multidisciplinary cooperation are key to saving pregnant females’ lives and improving the outcomes of perinatal infants.
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Affiliation(s)
- Lei Yang
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
| | - Na Liu
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
| | - Yan Long
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China
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Kim TG, Sudhof LS, Liu FW, Shainker SA. Spontaneous hemoperitoneum in pregnancy due to endometriosis. Journal of Endometriosis and Pelvic Pain Disorders 2020; 12:124-7. [DOI: 10.1177/2284026520942432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.
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Leone Roberti Maggiore U, Inversetti A, Schimberni M, Viganò P, Giorgione V, Candiani M. Obstetrical complications of endometriosis, particularly deep endometriosis. Fertil Steril 2017; 108:895-912. [PMID: 29202964 DOI: 10.1016/j.fertnstert.2017.10.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue.
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Affiliation(s)
| | - Annalisa Inversetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Schimberni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Giorgione
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Rafi J, Mahindrakar G, Mukhopadhyay D. Endometriosis Nodule Causing Spontaneous Haemoperitoneum in Pregnancy: A Case Report and Literature Review. Case Rep Obstet Gynecol 2017; 2017:3480287. [PMID: 28536663 DOI: 10.1155/2017/3480287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 11/18/2022] Open
Abstract
Spontaneous haemoperitoneum in pregnancy (SHiP) due to endometriosis is a very rare condition and this is a case of a 41-year-old primigravida, who presented at 32 weeks with sudden onset of severe lower abdominal pain without any uterine activity. This was a dichorionic-diamniotic twin pregnancy, following in vitro fertilisation for subfertility secondary to severe endometriosis. On admission, pain score was eight, with ten being the maximum of the scale. The vital signs were stable. Abdominal palpation revealed generalised tenderness with no guarding or palpable contraction. There was no evidence of bleeding and the cervical os was closed on speculum examination. The cardiotocograph (CTG) was pathological and a plan was made to deliver the babies with emergency caesarean section. Intraoperatively, there was massive haemoperitoneum which was managed successfully with the involvement of multidisciplinary input from general surgeons and urologists with optimum maternal and fetal outcome.
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Stochino Loi E, Darwish B, Roman H. Author's Reply. J Minim Invasive Gynecol 2016; 23:1201. [DOI: 10.1016/j.jmig.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/03/2016] [Indexed: 11/29/2022]
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Lier MCI, Malik RF, van Waesberghe JHTM, Maas JW, van Rumpt-van de Geest DA, Coppus SF, Berger JP, van Rijn BB, Janssen PF, de Boer MA, de Vries JIP, Jansen FW, Brosens IA, Lambalk CB, Mijatovic V. Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series. BJOG 2016; 124:306-312. [DOI: 10.1111/1471-0528.14371] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- MCI Lier
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - RF Malik
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - JHTM van Waesberghe
- Department of Radiology; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - JW Maas
- Department of Obstetrics & Gynaecology; Maxima Medical Centre; Veldhoven the Netherlands
| | | | - SF Coppus
- Department of Obstetrics & Gynaecology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - JP Berger
- Department of Obstetrics & Gynaecology; Bronovo Hospital; Den Haag the Netherlands
| | - BB van Rijn
- Department of Obstetrics; Wilhelmina Children's Hospital Birth Centre; University Medical Centre Utrecht; Utrecht the Netherlands
- Academic Unit Human Development and Health; Institute for Life Sciences; University of Southampton; Southampton UK
| | - PF Janssen
- Department of Obstetrics & Gynaecology; St. Elisabeth Hospital; Tilburg the Netherlands
| | - MA de Boer
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - JIP de Vries
- Department of Obstetrics & Gynaecology; VU University Medical Centre; Amsterdam the Netherlands
| | - FW Jansen
- Department of Obstetrics & Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - IA Brosens
- Leuven Institute for Fertility and Embryology; Leuven Belgium
| | - CB Lambalk
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine; VU University Medical Centre; Endometriosis Centre VUmc; Amsterdam the Netherlands
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Brosens IA, Lier MC, Mijatovic V, Habiba M, Benagiano G. Severe spontaneous hemoperitoneum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review. Fertil Steril 2016; 106:692-703. [DOI: 10.1016/j.fertnstert.2016.05.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
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Stochino Loi E, Darwish B, Abo C, Millischer-bellaiche A, Angioni S, Roman H. Recurrent Hemoperitoneum During Pregnancy in Large Deep Endometriosis Infiltrating the Parametrium. J Minim Invasive Gynecol 2016; 23:643-6. [DOI: 10.1016/j.jmig.2016.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 11/21/2022]
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Santulli P, Bourdon M, Presse M, Gayet V, Marcellin L, Prunet C, de Ziegler D, Chapron C. Endometriosis-related infertility: assisted reproductive technology has no adverse impact on pain or quality-of-life scores. Fertil Steril 2016; 105:978-987.e4. [DOI: 10.1016/j.fertnstert.2015.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 01/24/2023]
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Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2015; 22:70-103. [PMID: 26450609 DOI: 10.1093/humupd/dmv045] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships. METHODS This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article. RESULTS Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome. CONCLUSIONS Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
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Affiliation(s)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Annalisa Inversetti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Veronica Giorgione
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Via Olgettina 58, 20132 Milano, Italy
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Buggio L, Pagliardini L, Gentilini D, De Braud L, Viganò P, Vercellini P. A Rare Familial Case of Endometriosis with Very Severe Gynecological and Obstetric Complications: Novel Genetic Variants at a Glance. Gynecol Obstet Invest 2014; 77:201-4. [DOI: 10.1159/000360290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
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Doger E, Cakiroglu Y, Yildirim Kopuk S, Akar B, Caliskan E, Yucesoy G. Spontaneous rupture of uterine vein in twin pregnancy. Case Rep Obstet Gynecol. 2013;2013:596707. [PMID: 24455353 PMCID: PMC3880742 DOI: 10.1155/2013/596707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/01/2013] [Indexed: 12/14/2022] Open
Abstract
Objective. Aim of our study is to present a case of a twin pregnancy following invitro fertilization cycle complicated with hemoperitoneum at third trimester. Case. A 26-year-old nulliparous pregnant woman at 32 weeks of gestation with twin pregnancy following invitro fertilization cycle complained of abdominal pain. After 48 hours of admission, laparotomy was performed with indications of aggravated abdominal pain and decreased hemoglobin levels. Utero-ovarian vein branch rupture was detected on the right posterior side of uterus and bleeding was stopped by suturing the vein. Etiopathogenesis of the present case still remains unclear. Conclusion. Spontaneous rupture of the uterine vessels during pregnancy is a rare complication and may lead to maternal and fetal morbidity and mortality. Diagnosis and treatment are based on the clinical symptoms of acute abdominal pain and laboratory tests of hypovolemic shock signs.
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De Vincenzo R, Zannoni GF, Ricci C, Conte C, Masciullo V. Bowel Endometriosis with Hemoperitoneum Complicating Pregnancy. Journal of Endometriosis and Pelvic Pain Disorders 2013; 5:166-9. [DOI: 10.5301/je.5000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Case Report We report a case of bowel endometriosis complicated by spontaneous hemoperitoneum and miscarriage in a 33-year-old primigravida at the 24th week of gestation. An emergency laparotomy showed spontaneous rupture of the left uterine artery and bowel wall endometrioma. Artery suture, bowel resection and cesarean section on demised fetus were performed. Conclusions Although pregnancy may have beneficial effects on endometriosis, rare but significant endometriosis-associated pregnancy complications may also occur.
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Brosens I, Brosens JJ, Fusi L, Al-Sabbagh M, Kuroda K, Benagiano G. Risks of adverse pregnancy outcome in endometriosis. Fertil Steril 2012; 98:30-5. [DOI: 10.1016/j.fertnstert.2012.02.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 01/13/2012] [Accepted: 02/16/2012] [Indexed: 01/08/2023]
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Reif P, Schöll W, Klaritsch P, Lang U. Rupture of endometriotic ovarian cyst causes acute hemoperitoneum in twin pregnancy. Fertil Steril 2011; 95:2125.e1-3. [DOI: 10.1016/j.fertnstert.2011.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/13/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
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Nakaya Y, Itoh H, Muramatsu K, Otome M, Kobayashi Y, Hirai K, Uchida T, Suzuki K, Sugihara K, Kanayama N. A case of spontaneous rupture of a uterine superficial varicose vein in midgestation. J Obstet Gynaecol Res 2011; 37:1149-53. [DOI: 10.1111/j.1447-0756.2010.01489.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tourette C, Carcopino X, Taranger-Charpin C, Boubli L. Une cause inattendue d’hémopéritoine en cours de grossesse. ACTA ACUST UNITED AC 2011; 40:81-4. [DOI: 10.1016/j.jgyn.2010.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 05/31/2010] [Accepted: 06/14/2010] [Indexed: 11/28/2022]
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Brouckaert OM, Oostenveld E, Quartero H. Spontaneous hemoperitoneum and fetal demise in a nulliparous woman requiring hysterectomy with fetus in situ. Int J Gynaecol Obstet 2010; 110:273-273. [DOI: 10.1016/j.ijgo.2010.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 04/07/2010] [Accepted: 04/28/2010] [Indexed: 11/17/2022]
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Ueda Y, Enomoto T, Miyatake T, Fujita M, Yamamoto R, Kanagawa T, Shimizu H, Kimura T. A retrospective analysis of ovarian endometriosis during pregnancy. Fertil Steril 2010; 94:78-84. [DOI: 10.1016/j.fertnstert.2009.02.092] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 02/03/2009] [Accepted: 02/27/2009] [Indexed: 11/27/2022]
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Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril 2009; 92:1243-1245. [PMID: 19439293 DOI: 10.1016/j.fertnstert.2009.03.091] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/25/2009] [Accepted: 03/26/2009] [Indexed: 12/14/2022]
Abstract
Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but dramatic cause of perinatal mortality and morbidity. Emerging evidence suggests that pelvic endometriosis may play an important role in the pathogenesis of SHiP.
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Affiliation(s)
- Ivo A Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - Luca Fusi
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Jan J Brosens
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, United Kingdom
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