July 21st, 2018

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Unexplained Prelabor Broad Ligament Bleeding in a Preterm Primigravida: A Case Report
Authors:  Nina Reza Pour, M.D., Janet Crofts, M.B.Ch.B., FRANZCOG, and Farhad Rahimpanah, M.B.B.S., FRANZCOG
BACKGROUND: Hemoperitoneum resulting from rupture of the uteroovarian vessels and broad ligament is a rare complication of pregnancy.

CASE: A 25-year-old primigravid woman at 24 weeks’ gestation was admitted with abdominal pain. There was no history of trauma, and she was stable from an obstetric point of view. She underwent diagnostic laparoscopy because of progressive abdominal symptoms. Significant hemoperitoneum including old clot was found on entry. Exploration revealed normal-appearing ovaries and tubes, but defects were noted in the broad ligaments with ongoing fresh bleeding. Laparoscopy was converted to midline laparotomy due to the gravid uterus and difficult access. Bilateral full thickness defects of the broad ligaments were noted with multiple exposed bleeding vessels that were sutured to achieve hemostasis. She remained stable and was discharged home on day 11 post-surgery. At this stage the pregnancy continues with no apparent compromising fetal effects seen on formal ultrasound assessment.

CONCLUSION: Although seemingly a rare occurrence, the differential diagnosis of bleeding broad ligament must be considered in a pregnant patient presenting with sudden onset of abdominal pain and features of acute abdomen, which requires prompt surgical intervention to achieve an acceptable outcome.
Keywords:  abdomen, acute; broad ligament; hemoperitoneum; pregnancy; pregnancy complications; prelabor; uterus
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