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Ovarian Artery Aneurysm Rupture Presenting as Abdominal Pain in the Pregnant Patient
Abstract Number: T-49
Abstract Type: Case Report/Case Series
Spontaneous rupture of an ovarian artery aneurysm is an exceedingly rare pathology that occurs most commonly during the peripartum and early postpartum periods. Less than 15 cases have been reported in the literature. The aneurysmal rupture is thought to result from hemodynamic and hormonal changes during pregnancy. Here we present a young G2P1 women at 25 weeks gestation who presented to triage in the labor and delivery suite with vague cramping abdominal pain. Vital signs were initially stable, and pain improved to the point that the patient was discharged home, however, prior to leaving she suddenly became hypotensive and tachycardic. A FAST exam was performed showing free fluid in the abdomen. Concurrently, fetal heart rate monitoring revealed severe decelerations necessitating emergency Cesarean delivery. In the operating room, emergent Cesarean was performed under GA, and upon opening of the abdomen the surgical team noticed several liters of blood in the abdomen. Massive transfusion protocol was initiated, and the young women was successfully resuscitated while bleeding was controlled with ligation of her ovarian artery. The newborn, however, had Apgar scores of 1 and 2 at one and five minutes respectively. Care of the newborn was transferred to the neonatal intensive care unit, but withdrawn on day of life #2. To my knowledge, this is the only case reported aneurysmal rupture in the antepartum period proceeding labor and leading ultimately to fetal demise. Although rupture of an ovarian artery aneurysm is an incredibly rare event, it is life-threatening to both mother and child, and is often associated with a non-specific clinical picture. Awareness of this pathology may lead to early diagnosis and treatment.
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