title: [Spontaneous intra-abdominal bleeding in twin pregnancy--case report].
abstract: BACKGROUND
  Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy.
  
  
  METHODS
  We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful.
  
  
  CONCLUSIONS
  The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the foetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.
authors.forename: Milica
authors.initials: M
authors.lastname: Berisavac
authors.forename: Radimila
authors.initials: R
authors.lastname: Sparić
authors.forename: Miroslava
authors.initials: M
authors.lastname: Pervulov
authors.forename: Ljubica
authors.initials: L
authors.lastname: Arsenijević
authors.forename: Svetlana
authors.initials: S
authors.lastname: Spremović-Radjenović
authors.forename: Svetlana
authors.initials: S
authors.lastname: Vrzić-Petronijević
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Marković
authors.forename: Srboljub
authors.initials: S
authors.lastname: Milicević
mesh_terms: D000328:Adult; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000601:surgery; D011263:Pregnancy Trimester, Third; D011272:Pregnancy, Multiple; D012422:Rupture, Spontaneous; D014427:Twins; D014599:Uterus / Q000098:blood supply*; D014648:Varicose Veins / Q000150:complications* / Q000473:pathology