Massive maternal haemorrhage: a rare case of ruptured uterin
This case, published in The Journal of Obstetrics and Gynecology of India is of a booked primigravida, with otherwise uneventful pregnancy, who suffered a massive haemoperitoneum.

On laparotomy, the only cause found was a small uterine varix on the posterior uterine surface. The patient survived after multiple transfusions, but it led to a fresh stillborn baby. Immediate action is the only answer to improving maternal and foetal survival.

A 25-year-old booked, low-risk primigravida, case, presented to the gynaecological emergency at 1600 h in labour at term. Systemic and general physical examinations were normal. On per abdomen examination, there were mild contractions with a single live foetus in cephalic presentation. On per vaginal examination, cervix was soft, posterior, admitting tip of finger and vertex was at −3 station.

The patient was left for spontaneous progress of labour which was partographically charted. At around 01:00 h, she complained of sudden acute pain abdomen and became agitated, the foetal heart sound could not be localized, and the patient collapsed. Examination revealed free fluid in the abdomen with the uterine contour maintained.

At laparotomy, about 3.5 l of haemoperitoneum was drained and a fresh stillborn baby was delivered by caesarean section. No major bleeding vessel was seen except a small profusely bleeding vessel on the posterior surface of the uterus which was secured.

Further exploration of the abdominal cavity revealed no abnormality. The post-operative period was uneventful, and she was discharged in good condition.

Major takeaway:-
Haemoperitoneum due to rupture of uterine vessels though a rare event is a potential catastrophe. Immediate laparotomy is essential and life-saving.

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