Splenic rupture after sexual intercourse in a pregnant woman: an extremely rare case

A 33-year-old pregnant woman presented at 36 weeks gestation to the emergency with acute abdominal pain that started after vaginal intercourse. No bruising was present on the abdominal examination. An emergent cesarean delivery was performed for resistant hypotension and collapse. A fetus with cardiac arrest was delivered, and active spleen bleeding was identified at the splenocolic and gastrosplenic ligament insertion. The patient had a conservative treatment of the spleen and an uncomplicated postoperative course. The infant was resuscitated and discharged after 18 days. In conclusion, traumatic spleen rupture is an etiology to consider in pregnant women presenting with acute abdominal pain following sexual intercourse. Early suspicion and emergent cesarean delivery are the keys to optimize maternal and perinatal outcomes. Lay Abstract: Although sexual activity is generally considered safe in pregnancy, we present a rare case of post-coital spleen rupture in a third-trimester pregnant woman. However, rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal morbidity. The aim of this article is to highlight the role of early suspicion to optimize maternal and perinatal outcomes.