Spontaneous hemoperitoneum in pregnancy from a ruptured superficial uterine vessel

A 31-year-old multipara woman pregnant at gestational age 32+ weeks with twins encountered hemoperitoneum resulting from superficial uterine vessel rupture during tocolytic course. The initial presentations were unspecific and sonographic examination was negative. Later the aggravated symptoms led to an impression of abruption placentae and emergent cesarean section was performed. A superficial venous bleeder was located on the posterior uterine wall and the internal bleeding was up to 3 L. Maternal and fetal outcome were good. Hemoperitoneum during pregnancy is rare but life-threatening to both mother and fetus, and it mimics placenta abruption in many ways. However, by careful investigations with cardiotocogram and bedside echo, they are quite distinguishable. Aggressive fluid replacement and immediate surgical intervention after rapid diagnosis provides the best prognosis.