Ectopic decidualization causing massive postpartum intraperitoneal hemorrhage.
BACKGROUND
Spontaneous intraperitoneal hemorrhage during pregnancy or in the postpartum period is a rare but dangerous phenomenon.


METHODS
A 41-year-old gravida 3 para 1, 9 days postpartum, presented with lower abdominal pain and hypovolemia. Emergent laparotomy revealed massive intraperitoneal hemorrhage caused by ectopic decidualization with vascular intrusion into the left hypogastric artery in an area of previously documented endometriosis.


CONCLUSIONS
Ectopic deciduosis is usually no more than a pathologic curiosity. In a pregnant patient with spontaneous intraperitoneal hemorrhage, however, it must be considered because it results in a high incidence of maternal and neonatal mortality.
O'Leary
Sharon M
SM
Department of Obstetrics and Gynecology, St Joseph Mercy Hospital, Ann Arbor, MI, USA. olearysh@trinity-health.org
D000328:Adult; D001803:Blood Transfusion; D002828:Choristoma / Q000150:complications*; D003656:Decidua; D004564:Electrocoagulation; D004715:Endometriosis / Q000150:complications / Q000601:surgery; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007044:Hysterectomy; D016239:MEDLINE; D010049:Ovarian Diseases / Q000601:surgery; D010052:Ovariectomy; D010532:Peritoneal Diseases / Q000209:etiology* / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy