Dual lives at risk: managing haemoperitoneum and splenic injury in pregnancy

A pregnant woman in her 20s, at 31 weeks gestation, presented with severe abdominal pain, reduced fetal movements and mild vaginal bleeding following a fall. Examination revealed pallor, a tense abdomen and absent fetal movements. Point-of-care ultrasound indicated haemoperitoneum and placental abruption. Emergency laparotomy and lower segment caesarean section were performed, delivering a 1 kg neonate with Apgar scores of 5 and 7. Intraoperative findings included 3 L haemoperitoneum, placental abruption and splenic hilar vascular injury, necessitating splenectomy. The mother received blood transfusions and postsplenectomy vaccinations and recovered well postoperatively. She was discharged on day 12 in a stable condition. The neonate required neonatal intensive care unit for prematurity but demonstrated normal growth and neurodevelopment at follow-ups.