Hemoperitoneum during pregnancy with endometriosis; report of four cases

Background: Endometriosis is a chronic inflammatory gynecologic disease. Problems associated with endometriosis include dysmenorrhea, dyspareunia, and infertility. While endometriosis does not generally cause complications during pregnancy, endometriosis clearly causes complications before pregnancy.
Cases: We report four patients with endometriosis who developed a hemoperitoneum during pregnancy, suggesting that endometriosis may be involved in the development of a hemoperitoneum. The patients were diagnosed with endometriosis during surgery or underwent laparoscopic resection of endometriosis. There were one hemoperitoneum that occurred in the second trimester and one hemoperitoneum occurred in the third trimester. Two hemoperitoneums occurred at the time of vaginal delivery.
Conclusion: A spontaneous hemoperitoneum during pregnancy is a rare and life-threatening condition because of the high maternal and fetal mortality rates. The presence of surgical scar tissue and deep infiltrated endometriotic lesions located under dense adhesions in the cul-de-sac could have been avulsed by uterine contractions and pushing in labor.