5th International Conference on Gynecology and Obstetrics

Fernanda Taliberti Pereto Meyer graduated in Medicine from São Paulo State University (UNESP), Brazil, in 2001. She completed her residency in Obstetrics and Gynecology at Hospital das Clínicas, University of São Paulo (USP), in 2005. She has developed her clinical and academic career in Obstetrics and Gynecology, with particular expertise in high-risk obstetrics and fetal medicine. She currently works as a Hospital Assistant Physician at ULS Cova da Beira, Portugal, and as an Invited Assistant Professor at the Faculty of Medicine of the University of Beira Interior (UBI), Covilhã, Portugal. Her main clinical and academic interests include high-risk pregnancy, maternal-fetal health and fetal medicine. Her professional activity combines clinical practice, medical education and the training of medical students and healthcare professionals in Obstetrics and Gynecology.

Endometriosis is a chronic, oestrogen-dependent inflammatory disease associated with several obstetric and puerperal complications, including spontaneous hemoperitoneum. We report the case of a 26-year-old primigravida with a history of severe dysmenorrhoea, deep dyspareunia and previous imaging findings suggestive of endometriosis. At 36+6 weeks of gestation, premature rupture of membranes occurred, followed by a dystocic vaginal delivery requiring vacuum extraction. Twenty-four hours postpartum, the patient developed progressive diffuse abdominal pain, abdominal distension and haemodynamic instability, without significant vaginal bleeding. Haemoglobin decreased from 10.4 to 6.8 g/dL. Ultrasonography and computed tomography revealed a moderate-to-large hemoperitoneum. Exploratory laparotomy identified approximately 1300 mL of blood and clots, diffuse bleeding from a friable posterior uterine serosa, an actively bleeding right adnexal vessel, pelvic adhesions and superficial lesions suggestive of endometriosis. Surgical haemostasis was achieved by ligation of the bleeding vessel and suturing of the haemorrhagic uterine areas, with favourable postoperative recovery. Postpartum hemoperitoneum is exceptionally rare and may be difficult to recognise, particularly after vaginal delivery and in the absence of significant vaginal haemorrhage. Endometriosis may contribute through vascular fragility and mechanical stress associated with labour, although a direct causal relationship cannot be established. Prompt recognition and surgical management are essential to prevent severe maternal morbidity.