title: Rupture of renal artery aneurysm during late pregnancy: clinical features and diagnosis.
abstract: OBJECTIVE
  Rupture of renal artery aneurysm during pregnancy is a severe complication with high mortality and morbidity for mother and fetus, and diagnosis is difficult. The clinical presentation is easily confused with more common conditions like placental abruption, and most of the cases are diagnosed with timely delay.
  
  
  METHODS
  We present the case of a patient with spontaneous rupture of an aneurysm of the left renal artery during late pregnancy and summarize the previous reports of ruptured renal artery aneurysm during pregnancy and early postpartum period.
  
  
  RESULTS
  Regarding all published cases up to now (n = 32), 65.6% of mothers and 40.6% of fetuses survived. The rupture occurred in 68.7% in the third trimester and in 6.3% shortly postpartum. In our case, the increase of maternal serum lactate in a hemodynamically stable patient lead to diagnosis.
  
  
  CONCLUSIONS
  Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with flank pain. Early diagnosis and immediate intervention are important for achieving better outcomes for mother and fetus. Careful surveillance and laboratory results like serum lactate may lead to diagnosis even in hemodynamically stable patients.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany. Astrid.Hellmund@ukb.uni-bonn.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Hellmund
authors.affiliation: Department of Radiology, University Hospital Bonn, Bonn, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Fingerhut
authors.affiliation: Department of Urology, University Hospital Bonn, Bonn, Germany.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Waltraut M
authors.initials: WM
authors.lastname: Merz
authors.affiliation: Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gembruch
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012077:Renal Artery; D012422:Rupture, Spontaneous
keywords: Fetus; Labor; Pregnancy; Rupture of renal artery aneurysm