Spontaneous hemoperitoneum in a twin pregnancy complicated by endometriosis

Endometriosis is a common gynecologic condition in reproductive age. It is commonly believed that pregnancy has beneficial effects on endometriosis by reducing the symptoms. Although severe endometriosis is commonly associated with infertility, assisted reproductive technology such as 'in vitro fertilisation-embryo transfer', enables more patients with severe endometriosis to conceive.

A primigravida with a twin pregnancy presented acute abdominal pain and hypovolemic shock at 33 weeks of gestation. Ultrasound examination revealed the absence of fetal heartbeat in one fetus and serious bradycardia in the other without echographic signs of placental abruption. Immediate laparotomy revealed massive hemoperitoneum resulting from spontaneous rupture of right uterine vessels. Two demised fetuses were delivered by cesarean section and hemostasis was accomplished. According to the literature reported, endometriosis may be involved in the rupture of these vessels.