Case series of 9 cases of intra-abdominal hemorrhage in mid- to late-term pregnancy.

OBJECTIVE

To investigate the etiology, clinical characteristics, and maternal and fetal outcomes of intraperitoneal hemorrhage in mid- to late-term pregnancy.

METHODS

A retrospective analysis was conducted on the clinical data of 9 patients with intraperitoneal hemorrhage in mid- to late-term pregnancy who were admitted to Hangzhou First People's Hospital from January 2019 to April 2025.

RESULTS

Among the 9 cases, 4 cases (4/9) were due to uterine rupture hemorrhage, 1 case (1/9) due to splenic artery aneurysm rupture hemorrhage, and 4 cases (4/9) due to uterine vascular rupture hemorrhage. Among them, 8 patients had a history of uterine surgery and 1 patient had a history of splenic artery aneurysm.Except for the case of uterine rupture during trial of labor in a patient with a scarred uterus, the main clinical manifestation in all patients was abdominal pain (8/9). All patients underwent exploratory laparotomy, along with cesarean section or fetal extraction via laparotomy. Among the 9 patients, except for 1 patient who died, the rest of the patients recovered well and were discharged. Among the 5 patients who entered the perinatal period, 1 experienced fetal death in utero, while the remaining 4 had a good prognosis.

CONCLUSION

When encountering intraperitoneal hemorrhage in mid- to late-term pregnancy, multiple etiologies should be considered; in particular, uterine rupture and uterine vascular rupture should be highly suspected. Intraperitoneal hemorrhage, regardless of the underlying cause, poses a serious threat to both maternal and fetal lives due to the poor perinatal prognosis, and should therefore be managed actively.