Spontaneous rupture of subserous uterine veins during late pregnancy after in vitro fertilization

OBJECTIVE: To report the clinical presentation and treatment of spontaneous rupture of uterine surface veins during late pregnancy after in vitro fertilization (IVF). DESIGN: Case report. SETTING: Medical Unit of Third Hospital of Peking University, Beijing, China. PATIENT(S): A total of 573 pregnancies resulting from IVF in our hospital were reviewed for examples of spontaneous rupture of uterine veins. INTERVENTION(S): Data were obtained from medical charts, delivery summaries, and surgical reports in the historical files. MAIN OUTCOME MEASURE(S): Explorative laparotomy was performed. RESULT(S): Three women were found experiencing significant intra-abdominal bleeding in the third trimester of pregnancy due to a lesion resulting from endometriosis and chronic pelvic inflammatory disease. The intra-abdominal bleeding occurred between 29 and 35 weeks of gestation. A major prenatal symptom was severe abdominal pain in all of the cases. The pain was not relieved by the application of tocolytics or mild analgesics. Explorative laparotomy, performed in all three cases, revealed the presence of massive intra-abdominal bleeding stemming from subserous uterine veins. Fetal death occurred in one case. Immediate institution of effective resuscitative measures and early surgical intervention were essential to both fetal and maternal survival. CONCLUSION(S): Patients undergoing IVF treatment may be at increasing risk for intra-abdominal bleeding in the third trimester of pregnancy.