Idiopathic uterine artery injury

Abstract

Objective: To report the case of a patient who was on the 18º week of pregnancy and evolves with hemoperitoneum followed by signs of hemodynamic shock and urgent laparotomy required, discussing the possible diagnostic hypotheses. Case detail: Female patient, 40 years old, G3P1A1C1, 18 weeks pregnant, without previous comorbidities, started with asthenia and abdominal pain. After initial exams that showed anemia and the presence of fluid in the abdominal cavity, the patient began to show signs of hemodynamic shock, requiring emergency laparotomy. During surgery, a partial rupture of the left uterine artery with active bleeding was observed. After the surgical repair, however, after a few days, the patient developed fetal death. Final considerations: The rupture of uterine vessels during pregnancy is a rare event. In the few cases described in the literature, the vast majority occur around the second half of pregnancy and some cases contemplate the puerperium. The exact etiology of this type of injury remains unknown, but some factors are indicated as adjuvants in this process. Despite being a difficult diagnosis, early intervention is essential for maternal and fetal survival.