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A 37-year-old woman at 27 + 0 weeks presented with left upper quadrant abdominal pain; imaging showed a localized hematoma near the left uterine fundus without active bleeding. During conservative management, sudden severe pain with fetal heart rate decelerations occurred at 27 + 6 weeks, requiring emergency cesarean delivery. Intraoperative findings revealed ~2400 mL hemoperitoneum from rupture of a superficial fundal vein, controlled with a fibrin sealant patch, with favorable maternal and neonatal outcomes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/massive-hemoperitoneum-caused-by-spontaneous-rupture-of-a-superficial-uterine-fundal-vein-during-preterm-labor-a-case-report/461491/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/massive-hemoperitoneum-caused-by-spontaneous-rupture-of-a-superficial-uterine-fundal-vein-during-preterm-labor-a-case-report/461491.png","ImageObject",300,407,{"name":92,"@type":93},"Blue Pony","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-09","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is spontaneous hemoperitoneum from a superficial uterine fundal vein considered exceptionally uncommon?","Question",{"text":112,"@type":113},"The condition involves rupture of a superficial uterine fundal vein in an unscarred uterus, which is described as exceptionally rare, with only isolated past cases reported.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What clinical presentation preceded the emergency cesarean delivery?",{"text":117,"@type":113},"At 27 + 0 weeks, the patient had left upper quadrant abdominal pain and imaging showed a localized hematoma adjacent to the left uterine fundus without active bleeding; deterioration occurred at 27 + 6 weeks with sudden severe pain and fetal heart rate decelerations.",{"name":119,"@type":110,"acceptedAnswer":120},"What confirmed the diagnosis and how was bleeding managed intraoperatively?",{"text":121,"@type":113},"Intraoperative findings showed approximately 2400 mL of hemoperitoneum caused by rupture of the superficial fundal vein, and bleeding was controlled using a fibrin sealant patch, with the uterus otherwise intact.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461491,1791032203,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46},962090760266,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Report  \nMassive Hemoperitoneum Caused by Spontaneous Rupture of a Superficial Uterine Fundal Vein During Preterm Labor:  \nA Case Report  \nWon-Kyu Jang  and Hyun Mi Kim *  \nReceived: 5 December 2025  \nRevised: 27 December 2025  \nAccepted: 31 December 2025  \nPublished: 5 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; [cindeln@naver.com](cindeln@naver.com)  \n* [Correspondence: hyunmik@knu.ac.kr](Correspondence: hyunmik@knu.ac.kr); Tel.: +82-53-200-5724  \nAbstract  \nSpontaneous hemoperitoneum in pregnancy is rare, and rupture of a superficial uterine fundal vein in an unscarred uterus is exceptionally uncommon. A 37-year-old woman at 27 + 0 weeks presented with left upper quadrant abdominal pain, and imaging revealed a localized hematoma adjacent to the left uterine fundus without active bleeding. During conservative management, she developed sudden severe pain with fetal heart rate decelerations at 27 + 6 weeks, prompting emergency cesarean delivery. Intraoperative findings showed approximately 2400 mL of hemoperitoneum caused by rupture of a superficial fundal vein, with the uterus otherwise intact, and bleeding was controlled with a fibrin sealant patch. Maternal recovery and neonatal outcome were favorable. This case underscores that rupture of superficial uterine veins should be considered in pregnant patients presenting with unexplained hemoperitoneum during pregnancy.  \nKeywords: hemoperitoneum; uterine vein rupture; superficial fundal vein; preterm labor; pregnancy; obstetric emergency  \n1. Introduction  \nSpontaneous hemoperitoneum during pregnancy is an uncommon but potentially lifethreatening condition, with recent reports emphasizing its variable presentation and diagnostic difficulty [1,2] . Various causes have been described, including endometriosis-related vessel fragility, adnexal vascular rupture, and idiopathic intraperitoneal bleeding [1,3,4] . However, bleeding originating from superficial uterine vessels—particularly on the fundal serosa—remains exceptionally rare, with only isolated cases documented in the past decade [2,4] .  \nPhysiologic changes in pregnancy may contribute to venous susceptibility, including marked dilation of uterine and pelvic veins, increased venous capacitance, and elevated intra-abdominal pressure, all of which may predispose fragile vessels to rupture [3–5] . Although venous bleeding is low-pressure, the gravid uterus receives substantial blood flow, allowing rapid accumulation of intraperitoneal blood even from small vascular disruptions [2,5] . Recent case reports demonstrate that clinical deterioration or fetal compromise can occur abruptly, frequently requiring emergency surgical intervention [1–4] .  \nBecause of its rarity and nonspecific early symptoms, spontaneous rupture of a superficial uterine fundal vein remains a diagnostic challenge. Awareness of this condition is important when evaluating pregnant patients with unexplained abdominal pain or hemoperitoneum [1–3] .  \nDespite improvements in imaging modalities, distinguishing superficial venous rupture from other causes of hemoperitoneum remains challenging, particularly in the context of preterm labor where abdominal pain may be attributed to uterine activity [6,7] . Recent studies emphasize the importance of integrating clinical findings, hemodynamic trends, and subtle imaging clues when evaluating atypical or localized hemoperitoneum [6–8] . A more detailed understanding of this rare entity may aid clinicians in identifying early warning signs and determining the optimal timing of intervention to prevent maternal or fetal compromise [7,8] .  \nHere, we describe a case of massive hemoperitoneum caused by rupture of a superfic","cbCaiu6TkoBzzVGp","https://ap.wps.com/l/cbCaiu6TkoBzzVGp","pdf",4065381,"English","# Abstract\n# 1. Introduction\n# 2. Case Report","[{\"question\":\"Why is spontaneous hemoperitoneum from a superficial uterine fundal vein considered exceptionally uncommon?\",\"answer\":\"The condition involves rupture of a superficial uterine fundal vein in an unscarred uterus, which is described as exceptionally rare, with only isolated past cases reported.\"},{\"question\":\"What clinical presentation preceded the emergency cesarean delivery?\",\"answer\":\"At 27 + 0 weeks, the patient had left upper quadrant abdominal pain and imaging showed a localized hematoma adjacent to the left uterine fundus without active bleeding; deterioration occurred at 27 + 6 weeks with sudden severe pain and fetal heart rate decelerations.\"},{\"question\":\"What confirmed the diagnosis and how was bleeding managed intraoperatively?\",\"answer\":\"Intraoperative findings showed approximately 2400 mL of hemoperitoneum caused by rupture of the superficial fundal vein, and bleeding was controlled using a fibrin sealant patch, with the uterus otherwise intact.\"}]","Massive Hemoperitoneum Caused by Spontaneous Rupture of a Superficial Uterine Fundal Vein During Preterm Labor - A Case Report | PDF",1790761718]