[Rupture of the uterine artery after spontaneous delivery with unusual course in childbed].

Haemorrhage from ruptured uterine vessels is a rare but life-threatening complication during pregnancy. The high rate of mortality associated with this condition is correlated to the rapidity of haematoma formation. The dynamics of this event become particularly evident at the time of birth when the uterus requires one-fifth of the cardiac output. This high rate of flow emphasizes the possible fatal consequences of delayed therapeutical intervention. Information available on the aetiology and pathogenesis of such events is poor, especially if an involvement of cervical vessels or extraperitoneal (incomplete) rupture of the uterus can be excluded. Diagnosis and therapy are based on the classical clinical symptoms of acute abdominal pain-and-shock symptomatology. We report on a 31-year old patient after spontaneous delivery and initially uneventful puerperium. She had to be laparotomised on the third day post partum because of pain and haemoglobin deficiency. We found a large retroperitoneal (supralevatorial) haematoma caused by ruptured lateral branches of the left arteria uterina. The uterus was preserved after haematoma removal and revision and suture of the bleeding vessels. The case reported on shows that peripartal rupture of arterial uterine vessels may turn out to be clinically relevant only after a relatively long time (> 72 hours). Only four comparable cases have been reported in the literature, the course being different from that in all the other cases. In all the documented cases arterial uterine haemorrhages resulted in short-term acute aggravation of the symptomatology with severe abdominal pain, haemodynamic collapse and simultaneous haemoglobin deficit. The case under report in the present paper was at first clinically occult and eventually developed a pathology that had not been described before. Its specific significance lies in illustrating the need for re-evaluating such initially hidden cases while paying special attention to ruptured uterine vessels.