Spontaneous Haemoperitoneum Following Normal Vaginal Delivery

Background: Spontaneous haemoperitoneum during pregnancy resulting from tear or rupture of a uterine or ovarian vessel is a rare yet catastrophic event, which can be a cause of maternal and foetal loss.

Case: A 31 year old woman, Para 6, arrived in our emergency in shock within 12 hours of delivery after an uneventful spontaneous vaginal delivery at a private clinic. Abdominal palpation revealed rigidity and tenderness and uterine fundus could not be appreciated. Ultrasound examination confirmed free fluid in the abdomen and pelvis. Liver, pancreas, gall bladder, spleen and pelvic organs were normal. No obvious source of bleeding was identified. After clinical and sonographic examnation, haemoperitoneum was suspected. Per operative findings were haemoperitoneum equivlent to 500 cc, uterus was intact, a small diverticulum was present on fundus and a small peritoneal tear was present on left posterior surface of uterus with oozing from underlying uterine vessels. Peritoneal tear was stitched along with bilateral uterine artery ligation. Complete haemostasis was achieved.

Result: Her postoperative period was uneventful and patient was discharged on 7th postopertive day.

Conclusion: Haemoperitoneum after normal vaginal delivery is rare but life threatening to mothers. Although very rare, obstetrician should be aware of this cause of acute abdominal pain and hypovolaemic shock in pregnancy. Close observation, prompt diagnosis and proper intervention are the keys to patient survival.