Haemoperitoneum Due to Cornual Endometriosis During Pregnancy Resulting in Intrauterine Death

EDITORIAL COMMENT: We accepted this case report for publication not only because of the rarity of an acute haemoperitoneum causing intrauterine fetal death in late pregnancy, but also because of the cause of the haemorrhage. There are cases where the cause of a haemoperitoneum is never found and indeed, when the editor was a resident medical officer at the Royal Women's Hospital, Melbourne, such a case resulted in a maternal death; this woman died during repeat laparotomy and possibly the source of the bleeding was a ruptured vein over the uterosacral ligament. One reviewer of this paper commented that the source of bleeding may have been an area of ectopic decidua formation rather than endometriosis. Ectopic decidua is frequently seen at Caesarean section involving the peritoneum of the uterus and broad ligaments. Occasionally it occurs outside the pelvis and when located in the renal pelvis can cause haematuria, sufficient in the case reported by Bettinger to result in nephrectomy to control the bleeding(A). Ectopic decidua is not biopsied at Caesarean section because of the risk of haemorrhage and is possibly best studied histologically in Caesarean hysterectomy specimens. (A) Bettinger HF. Ectopic decidua in the renal pelvis. J Path Bact 1949; 59: 686–687.