title: Severe intraabdominal bleeding caused by endometriotic lesions during the third trimester of pregnancy.
abstract: OBJECTIVE
  Endometriosis is known to be associated with an increased risk for early pregnancy complications, including ectopic pregnancy and miscarriage. However, little has so far been reported on complications linked to severe endometriosis occurring during the third trimester of pregnancy.
  
  
  METHODS
  A retrospective review of 800 women attending the endometriosis clinic of the Sheba Medical Center during the years 2002-2006 was performed. Cases with severe endometriosis and associated complications during late pregnancy were identified.
  
  
  RESULTS
  Three women were found who experienced significant intraabdominal bleeding in the third trimester of pregnancy attributed to a lesion resulting from severe endometriosis. The intraabdominal bleeding occurred between 26-29 weeks of gestation. In all cases the major presenting prenatal symptom was severe lower abdominal pain. The pain was not relieved by the administration of tocolytics or mild analgesics. Explorative laparotomy, performed in all 3 cases, revealed the presence of significant intraabdominal bleeding requiring immediate transfusion of blood products stemming from endometriotic lesions. Fetal complications occurred in all 3 cases.
  
  
  CONCLUSIONS
  The symptoms of endometriosis are often relieved during pregnancy. Yet lesions caused by severe endometriosis can lead to significant intraabdominal bleeding during the third trimester of the pregnancy. Physicians must be aware that close antenatal follow-up and prompt intervention may be required in such cases.
authors.affiliation: Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Katorza
authors.forename: D
authors.initials: D
authors.lastname: Soriano
authors.forename: D
authors.initials: D
authors.lastname: Stockheim
authors.forename: R
authors.initials: R
authors.lastname: Mashiach
authors.forename: M
authors.initials: M
authors.lastname: Zolti
authors.forename: D S
authors.initials: DS
authors.lastname: Seidman
authors.forename: E
authors.initials: E
authors.lastname: Schiff
authors.forename: M
authors.initials: M
authors.lastname: Goldenberg
mesh_terms: D000005:Abdomen; D015746:Abdominal Pain / Q000209:etiology; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies