Spontaneous rupture of broad ligament vein in twin pregnancy: a case report and literature review

Spontaneous uterine vein rupture in pregnancy is rare. This current case report presents a case of broad ligament vein rupture in spontaneous twin pregnancy that is even rarer. A female in her early 30s at the third trimester of a twin pregnancy presented with headache and left upper abdominal pain for 2 days. After admission, her blood pressure was 158/112 mmHg accompanied with increased blood lipids and proteinuria. Ultrasonography did not show any abnormalities. The main diagnoses included twin pregnancy with abdominal pain of unknown aetiology, preeclampsia and hyperlipidaemia. Her blood pressure and symptoms did not improve after administration of medications. An emergency caesarean section and laparotomy were then performed. Intraoperatively, bright red non-coagulated blood was observed within the pelvis and removed. After two healthy female babies were delivered, pelvic exploration revealed haematomas in the broad ligaments bilaterally and haemostatic sutures and clips were applied to successfully treat the ruptured vein. In cases of unexplained abdominal pain accompanied with fetal distress and haemodynamic instability, especially in twin pregnancy that can cause uterus over-expansion and broad ligament over-stretch, the possibility of spontaneous uterine vein rupture should be considered. Rapid diagnosis, immediate fluid replacement and prompt surgical intervention are essential for the safety of the mother and child.