An Unusual Cause of Post-cesarean Intraperitoneal Hemorrhage: Inadvertent Intra-abdominal Placement of a Femoral Venous Catheter.

Severe abruptio placentae is a major obstetric emergency that may require aggressive resuscitation and central venous catheterization. Femoral venous access is often selected in this context because of its accessibility and absence of pneumothorax risk; however, inadvertent intraperitoneal malposition of the catheter is an exceptionally rare and potentially life-threatening complication. We report the case of a 25-year-old woman at 36 weeks of gestation, admitted for abruptio placentae with intrauterine fetal death and hemorrhagic shock, who underwent emergency cesarean section and was transferred to the intensive care unit (ICU) postoperatively. A right femoral central venous catheter was inserted using the landmark-based technique in a single, apparently uneventful attempt. Postoperative anemia prompted transfusion, but hemoglobin paradoxically failed to improve and continued to decline from 8.2 to 7.8 g/dL despite two units of packed red blood cells, with no identifiable external source of bleeding. Progressive pelvic effusion on serial ultrasound, combined with abdominal distension and tachycardia, prompted surgical re-exploration on postoperative day two. Exploration revealed approximately 600 mL of hemoperitoneum, with the catheter tip identified within the right pelvic peritoneal cavity. The catheter was withdrawn under direct visual control with immediate cessation of bleeding, and the patient recovered fully. This case highlights a rare but serious complication of femoral catheterization, underscores the diagnostic importance of paradoxical hemoglobin kinetics as a signal of occult intraperitoneal hemorrhage, and supports systematic ultrasound guidance and post-insertion catheter verification in obstetric critical care settings.