SPONTANEOUS RUPTURE OF UTERINE VARICOSE VEIN AT 38 WEEKS OF PREGNANCY: A RARE CASE REPORT

Uterine and ovarian vessels supply the uterus & ovaries respectively. In pregnancy especially after 20weeks, uterus greatly enlarges as the fetus grows. To fulfill the demand, blood flow through these vessels much increases. As a result these vessels dilate, become tortuous (called varicose). Their wall may become thinned out in some places, where rupture may occur. The rupture is more common in varicose veins as their wall is thinner than arteries. Generally the rupture is spontaneous; but may be due to trauma, which may be direct abdominal trauma or trauma due to coughing, defecation, coitus or pushing phase of second stage of labour. Rupture is generally before onset of labour, but may be intrapartum or postpartum. It is a very dangerous life threatening condition, as massive amount of blood is collected either intraperitoneally or retroperitoneally. Diagnosis is very difficult even with the help of USG. In suspicious cases, urgent laparotomy is to be done, which may save the lives of the mother and fetus. Ligation of the offending vessel may be required.