Intra-abdominale bloeding na spontane vaginale partus

Casuïstiek
19-11-2019
Inge M. Zeilstra en Harry Visser

Intra-abdominal bleeding following spontaneous vaginal delivery

Background

Intra-abdominal bleeding following spontaneous delivery is a rare but potentially life-threatening complication. Usually the haemorrhage is the result of a rupture of a pseudoaneurysm of the uterine artery.

Case description

A 38-year-old female (gravida 4, para 2) was, at her own request and at 40 2/7 weeks of gestation, admitted to the delivery suite for induction of labour. A few hours following the uncomplicated delivery she suddenly developed severe pain in the upper abdomen. Laboratory diagnostics showed a haemoglobin level of 5.8 mmol/l. Ultrasound identified a lot of intra-abdominal fluid. ACT-angiogram confirmed the presence of intra-abdominal fluid, highly suggestive of a bleeding from the uterine artery or right ovarian vein. Therapeutic angiography was conducted, during which embolization of the right uterine artery was performed.

Conclusion

In post-partum women who experience severe abdominal pain and anaemia, but no vaginal blood loss, it is important to consider intra-abdominal bleeding.

Conflict of interest and financial support: none declared.