Spontaneous uterine artery rupture during pregnancy in a woman with sickle cell disease: a case report.
BACKGROUND
Spontaneous rupture of uterine vessels during pregnancy is rare and usually involves uteroovarian veins. Presenting symptoms include acute-onset abdominal pain and maternal hypovolemic collapse due to hemoperitoneum. An atypical case of subacute uterine artery rupture at 27 weeks of gestation occurred in a woman with sickle cell disease.


METHODS
A 28-year-old, nulliparous woman with sickle cell disease was admitted at 27 weeks of gestation for sharp abdominal pain radiating to the right flank. The first diagnosis included acute renal colic and a sickling vasoocclusive crisis. One week after admission the patient experienced paroxysmal, diffuse abdominal pain associated with acute fetal distress requiring an emergency cesarean section. Laparotomy revealed an 800-mL hemoperitoneum. Active bleeding from a ruptured uterine artery was observed and successfully treated by selective suture.


CONCLUSIONS
Spontaneous rupture of the uterine artery during pregnancy may present as a 2-step process.
Fiori
Olivia
O
Service of Gynecology and Obstetrics and Reproductive Medicine, Hôpital Tenon, Paris, France. ofiori@freesurf.fr
Prugnolles
Hervé
H
Darai
Emile
E
Uzan
Serge
S
Berkane
Nadia
N
D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001158:Arteries / Q000473:pathology*; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D012422:Rupture, Spontaneous; D014599:Uterus / Q000098:blood supply*