Splenic Artery Rupture in Pregnancy Causes Symptoms and Treatment

Splenic artery rupture during pregnancy is one of the most serious and rare medical emergencies that can affect a pregnant woman. It may occur suddenly and progress rapidly to internal bleeding, threatening the lives of both the mother and her fetus. The danger of this condition lies in its rarity and the difficulty of recognizing it in its early stages, as its symptoms may resemble those of common pregnancy-related complications. This makes prompt diagnosis and immediate medical intervention crucial for saving lives.Despite its rarity, splenic artery rupture during pregnancy requires special medical attention and a thorough understanding of its causes, associated risk factors, symptoms, diagnostic methods, and the latest management approaches. This highlights the importance of addressing splenic artery rupture in pregnant women as a life-threatening emergency that demands a high level of clinical vigilance and coordinated care among specialists in surgery, obstetrics, and anesthesiology. The primary goal is to save the mother's life while preserving fetal well-being whenever possible.

What Is Splenic Artery Rupture During Pregnancy?

Splenic artery rupture occurs when the wall of the artery supplying blood to the spleen tears, often as a result of the rupture of a splenic artery aneurysm. This can lead to severe internal bleeding into the abdominal cavity, potentially causing hemorrhagic shock that threatens the lives of both the mother and fetus if the condition is not diagnosed and treated promptly.

Can Splenic Artery Rupture Occur Without Previous Symptoms?

Yes. A splenic artery aneurysm may cause no noticeable symptoms and may remain undetected until rupture occurs. In some cases, bleeding occurs in two stages: an initial, limited bleed that temporarily stops, followed by severe intra-abdominal hemorrhage. Therefore, temporary improvement in pain does not necessarily mean that the danger has passed and should not delay urgent medical evaluation.

At What Stage of Pregnancy Does Splenic Artery Rupture Usually Occur?

Systematic reviews of published cases indicate that a substantial proportion of splenic artery ruptures during pregnancy occur in the third trimester, or the final three months of pregnancy. However, rupture can occur at any stage of pregnancy and may also develop during the postpartum period. Therefore, awareness of warning signs is essential throughout pregnancy and after delivery.

How Is Splenic Artery Rupture Diagnosed in Pregnant Women?

Diagnosis depends on assessing the mother's overall condition, performing a physical examination, conducting laboratory tests, and selecting appropriate imaging studies according to her hemodynamic stability. Diagnostic methods may include the following:

Does Splenic Artery Rupture Pose a Risk to the Fetus?

Yes. Splenic artery rupture can cause severe maternal internal bleeding, leading to low blood pressure and reduced delivery of oxygenated blood to the fetus. This may result in an abnormal fetal heart rate, oxygen deprivation, or fetal death in severe cases. Early diagnosis and urgent treatment are therefore essential to reduce complications and preserve the lives of both the mother and fetus whenever possible.

How Is Splenic Artery Rupture Treated During Pregnancy?

Splenic artery rupture is a medical emergency that requires immediate hospital treatment. The primary goals are to control the bleeding and stabilize the mother's circulation. Treatment options may include:

Managing this condition requires urgent coordination among surgeons, obstetricians, anesthesiologists, and neonatologists when necessary to ensure appropriate care for both the mother and fetus.

Is an Immediate Cesarean Section Necessary After Splenic Artery Rupture?

Not necessarily. An immediate cesarean section is not required in every case. The decision depends on the mother's hemodynamic stability, gestational age, fetal condition, and the urgency of controlling the bleeding.

The priority is to stabilize the mother and control the hemorrhage. The timing and mode of delivery should then be determined by the multidisciplinary medical team according to the clinical circumstances and the well-being of both the mother and fetus.

What Is the Maternal Mortality Rate Associated with Splenic Artery Rupture During Pregnancy?

Mortality rates associated with splenic artery rupture during pregnancy vary depending on the severity of bleeding, the speed of diagnosis, and the availability of appropriate medical intervention. According to a systematic review of 75 published cases, the maternal mortality rate was approximately 25.7%, while fetal mortality was approximately 50% among cases with relevant data available.

However, these figures should be interpreted with caution because they are based on cases published in the medical literature and may not accurately reflect current mortality rates across all hospitals. These findings highlight the importance of early diagnosis and prompt intervention to reduce complications and save the lives of both the mother and fetus.

Can Splenic Artery Rupture Be Prevented During Pregnancy?

Not all cases of splenic artery rupture can be prevented. However, detecting a splenic artery aneurysm before rupture may provide an opportunity for preventive treatment and reduce the risk of severe bleeding.

If a splenic artery aneurysm is diagnosed during pregnancy, the condition should be evaluated promptly by a specialized medical team to determine the severity of the aneurysm and select the most appropriate management strategy based on the mother's condition and gestational age.

Given the potentially serious consequences of splenic artery aneurysm rupture during pregnancy, early assessment and close medical monitoring are essential. Decisions about treatment should not be postponed until after delivery without a clear recommendation from the specialist team.

Can Splenic Artery Rupture Occur After Delivery?

Yes. Splenic artery rupture can occur during the postpartum period, not only during pregnancy. Therefore, women should be alert to sudden, severe abdominal or shoulder pain, particularly when accompanied by dizziness, fainting, cold sweating, or a rapid heartbeat.

These symptoms require immediate emergency medical evaluation because they may indicate internal bleeding that needs urgent intervention. The end of pregnancy does not eliminate the possibility of this life-threatening complication.

Which Medical Conditions Can Mimic the Symptoms of Splenic Artery Rupture During Pregnancy?

The symptoms of splenic artery rupture may resemble those of several obstetric and surgical emergencies, making diagnosis more challenging. The main conditions that may present similarly include:
- Ultrasound: May help detect fluid or blood within the abdominal cavity and, in some cases, assess the abdominal blood vessels.
- Color Doppler ultrasound: May help identify a splenic artery aneurysm and evaluate blood flow within the vessel.
- Computed tomography angiography (CTA): May be used to identify the site of rupture and the source of bleeding, depending on the clinical situation and the medical team's assessment of the risks and benefits.
- Emergency surgical exploration: May be necessary if the pregnant woman is hemodynamically unstable or has severe internal bleeding. Life-saving intervention should not be delayed solely to complete imaging studies.
- Hemodynamic resuscitation: Intravenous fluids and blood transfusions, including blood components when necessary, to replace blood loss and stabilize circulation.
- Emergency surgery: To control the bleeding, potentially involving ligation or repair of the affected artery, depending on the location and nature of the rupture.
- Splenectomy: Surgical removal of the spleen may be necessary in cases where the bleeding cannot be controlled by other means.
- Endovascular treatment: Catheter-based embolization may be used to block the bleeding artery in selected cases, depending on maternal stability and the availability of appropriate facilities and expertise.
- Fetal monitoring: Assessment of the fetal heart rate and overall condition, with appropriate interventions determined by gestational age and the stability of both the mother and fetus.
Placental abruption: Premature separation of the placenta from the uterine wall before delivery. It may cause abdominal pain, vaginal bleeding, or abnormalities in fetal well-being.
Uterine rupture: A serious obstetric complication that can cause sudden pain and internal bleeding.
Ectopic pregnancy: May cause life-threatening internal bleeding, particularly if the pregnancy ruptures. It is considered according to gestational age and the clinical context.
Other causes of internal bleeding: These include rupture of other blood vessels or intra-abdominal injuries.
Acute surgical abdominal conditions: Such as appendicitis and certain gastrointestinal disorders that may cause severe abdominal pain.
What Causes Splenic Artery Rupture During Pregnancy?

It is important to distinguish between rupture of the splenic artery itself and rupture of a splenic artery aneurysm. An aneurysm is an abnormal dilation of part of the arterial wall caused by weakening of the vessel. This dilation may eventually rupture, resulting in internal bleeding.

Splenic artery aneurysm rupture is an important cause to consider when sudden internal bleeding occurs during pregnancy.

The main causes and associated risk factors include:
Splenic artery aneurysm: One of the most important conditions associated with splenic artery rupture during pregnancy. An aneurysm may remain asymptomatic until it suddenly ruptures.
Hormonal changes during pregnancy: Hormonal changes may affect the structure and properties of blood vessel walls, potentially contributing to aneurysm enlargement and rupture risk.
Hemodynamic and circulatory changes: Blood volume and blood flow increase during pregnancy, potentially increasing stress on blood vessels affected by an aneurysm.
High blood pressure: Elevated blood pressure may increase stress on the arterial wall, although it is not a direct cause in every case.
Blood vessel wall disorders: Certain inherited connective tissue disorders and vascular diseases may increase the likelihood of aneurysm formation and rupture.
Direct abdominal trauma: Accidents or severe blows to the abdomen may injure blood vessels and cause bleeding.
Vasculitis or vascular infections: These are less common causes that may weaken the arterial wall and increase its susceptibility to rupture.
Nevertheless, rupture may occur without any identifiable risk factor or previously known cause. Pregnancy-related changes may increase the risk of rupture in an existing aneurysm, but this does not mean that rupture will occur in every pregnant woman.

What Are the Symptoms of Splenic Artery Rupture During Pregnancy?

Symptoms vary according to the amount of blood lost and the speed of bleeding. They may begin with sudden pain and rapidly progress to signs of severe internal hemorrhage. The symptoms can be divided into three main groups.

1. Early Symptoms
Sudden, severe pain in the upper abdomen, particularly on the left side or in the epigastric region.
Pain radiating to the left shoulder, known as Kehr's sign, which may result from diaphragmatic irritation caused by blood accumulating inside the abdominal cavity.
Nausea or vomiting.
Sudden weakness or fatigue.
Abdominal pain or distension due to internal bleeding.
2. Signs of Severe Internal Bleeding

As bleeding continues, signs of circulatory deterioration may develop, including:
Severe dizziness or fainting.
Pale skin and cold sweating.
Rapid heartbeat.
Low blood pressure.
Shortness of breath.
Confusion or loss of consciousness in advanced cases.
3. How Does Rupture Affect the Fetus?

Severe bleeding may lower the mother's blood pressure and reduce the delivery of oxygenated blood to the placenta. This can lead to fetal oxygen deprivation and an abnormal fetal heart rate. In severe cases, fetal death may occur.

For this reason, urgent intervention to control bleeding and restore maternal circulatory stability is essential to protect both the mother and fetus whenever possible.

Can the Pain Disappear and Then Return?

Yes. In some cases, an initial, limited bleed may temporarily become contained, followed by renewed or more severe bleeding. This can lead to sudden deterioration in the mother's circulatory condition.

Therefore, temporary improvement in pain does not necessarily mean that the underlying problem has resolved or that the danger has passed. Urgent medical evaluation remains essential.

How Is Splenic Artery Rupture Diagnosed During Pregnancy?

Diagnosis relies on evaluating symptoms and clinical signs, assessing hemodynamic stability, and performing appropriate laboratory tests and imaging studies.

When internal bleeding is suspected, this condition must be treated as a medical emergency. Assessment and necessary interventions should begin without delay while waiting for a particular diagnostic test.

1. Immediate Clinical Assessment

The first step is to evaluate the pregnant woman's overall condition, focusing on indicators of internal bleeding or hemorrhagic shock.

The assessment includes:

Measuring blood pressure, heart rate, respiratory rate, and level of consciousness.

Examining the abdomen for pain, distension, or signs of peritoneal irritation.

Looking for signs of internal bleeding, such as pallor, cold sweating, and dizziness.

Assessing fetal well-being and monitoring the fetal heart rate according to gestational age and maternal stability.

It is important to note that blood pressure may remain within the normal range during the early stages of bleeding. Therefore, an initially normal blood pressure reading does not exclude splenic artery rupture.

2. Required Laboratory Tests

Laboratory tests help assess the severity of bleeding, estimate treatment requirements, and prepare for emergency intervention when necessary. The main investigations include:

Complete blood count (CBC): Evaluates hemoglobin levels and platelet counts. However, hemoglobin may not decrease significantly during the early stages of acute hemorrhage.

Blood typing and crossmatching: Prepare for blood and blood component transfusion if required.

Coagulation tests: Assess the blood's ability to clot and identify coagulation abnormalities.

Kidney function tests: Help evaluate the patient's overall condition and determine the suitability of certain diagnostic procedures and treatments.

Lactate measurement: When hemorrhagic shock is suspected, lactate levels can help assess the severity of impaired tissue perfusion.

These laboratory tests cannot independently confirm splenic artery rupture. Their results must be interpreted alongside the patient's symptoms, physical examination, and medical imaging findings.

Not all these signs appear at the beginning. Therefore, the absence of some symptoms does not rule out dangerous internal bleeding.

3. Imaging Tests for Splenic Artery Rupture During Pregnancy

Imaging studies play a crucial role in detecting internal bleeding and identifying its source. The appropriate imaging method is selected according to the pregnant woman's hemodynamic stability and the level of suspicion for arterial rupture.

A. Abdominal Ultrasound (Ultrasound / FAST)

Ultrasound is used to rapidly detect free fluid within the abdominal cavity, which may represent blood resulting from internal bleeding. It can help guide the initial assessment; however, a negative result cannot definitively exclude splenic artery rupture.

B. Color Doppler Ultrasound

Color Doppler ultrasound helps assess blood flow within the splenic artery and may identify an aneurysm or associated vascular abnormalities. Its diagnostic accuracy depends on image quality and whether the artery can be adequately visualized.

C. Computed Tomography Angiography (CT Angiography)

CT angiography is one of the most important diagnostic investigations for identifying the location of an aneurysm, detecting arterial rupture, locating the source of bleeding, and assessing the extent of blood accumulation within the abdominal cavity.

It may be necessary during pregnancy when there is a clear medical indication. A potentially life-threatening diagnosis should not be delayed solely because the patient is pregnant. The medical team should carefully weigh the diagnostic benefits against the potential risks.

D. Catheter Angiography

Catheter angiography may be used to identify the precise location of bleeding. In suitable cases, it also allows therapeutic embolization to block the bleeding vessel.

The decision to use this procedure depends on the patient's hemodynamic stability, the nature of the vascular injury, and the availability of appropriate facilities and expertise.

4. When Is Surgery Necessary Without Completing All Imaging Tests?

If the pregnant woman is hemodynamically unstable or develops signs of severe internal bleeding or hemorrhagic shock, emergency surgery may be necessary to control the bleeding without waiting for all imaging investigations to be completed.

In these situations, immediate coordination is required among general surgeons or vascular surgeons, obstetricians, and anesthesiologists. A neonatal team should also be involved when necessary. The primary goal is to save the mother's life while preserving fetal well-being whenever possible.

Treatment of Splenic Artery Rupture During Pregnancy: Medications and Surgery

Splenic artery rupture during pregnancy is a medical emergency that can cause severe internal bleeding and hemorrhagic shock, threatening the lives of both the mother and fetus.

No medication alone can repair a ruptured artery or definitively stop the bleeding. Treatment therefore focuses on resuscitation, replacement of lost blood, urgent control of the bleeding source, and fetal monitoring.

Medical warning: If splenic artery rupture is suspected, the pregnant woman must be taken to the hospital immediately. She should not wait for the pain to improve or attempt home treatment.

Medical Treatment of Splenic Artery Rupture During Pregnancy

Medications, intravenous fluids, and blood products are administered in the hospital to support circulation, replace blood loss, and prepare the patient for the appropriate surgical or interventional procedure.

The main supportive treatments include:

Treatment	Purpose
Packed red blood cells	Replace lost blood and improve oxygen delivery to the organs.
Plasma and platelets	Replace clotting factors and platelets when necessary, according to bleeding severity and laboratory results.
Balanced intravenous crystalloids	Provide temporary circulatory support while avoiding excessive fluid administration.
Tranexamic acid	May be considered in selected cases according to the medical team's assessment and hemorrhage protocols; it is not a definitive treatment for arterial rupture.
Vasopressors	May be used if low blood pressure persists despite appropriate resuscitation, depending on the clinical situation.
Appropriate anesthetic agents and analgesics	Facilitate surgery and control pain under medical supervision.

The type of treatment and medication dosages are determined by the mother's condition, the severity of bleeding, laboratory results, and gestational age.

Medications that affect blood clotting, including aspirin and certain anti-inflammatory drugs, should not be taken independently when bleeding is suspected.

Surgical Treatment of Splenic Artery Rupture During Pregnancy

Surgery is one of the principal treatment options when rupture causes severe bleeding or hemodynamic instability. Its purpose is to identify the bleeding source and control it as quickly as possible.

1. Initial Resuscitation

Resuscitation begins while preparations for definitive treatment are underway. It includes:

Securing the airway and providing respiratory support when necessary.
Establishing appropriate intravenous access and administering blood products according to the severity of bleeding.
Continuously monitoring blood pressure, pulse, oxygen saturation, and level of consciousness.
Keeping the patient warm and monitoring body temperature and coagulation status.
Assessing fetal well-being according to gestational age and maternal stability.

In advanced pregnancy, the woman may be positioned with a left lateral tilt when appropriate to reduce compression of major blood vessels by the uterus. These supportive measures must not delay definitive control of the bleeding.

2. Open Surgery (Laparotomy)

Emergency open surgery may be required when bleeding is severe, the patient's circulation is unstable, or other methods cannot control the bleeding rapidly.

The main surgical steps may include:

Opening the abdomen: To gain rapid access to the abdominal cavity, identify the bleeding source, and control the hemorrhage.
Ligation of the bleeding artery: To stop blood flow from the injured vessel, depending on the location and nature of the rupture.
Splenectomy: Surgical removal of the spleen may be necessary when bleeding cannot be controlled using spleen-preserving techniques or when the nature of the injury requires removal.
Continued resuscitation: Replacing lost blood, correcting coagulation abnormalities, and monitoring vital organ function.

The choice of surgical procedure depends on the location of the rupture, the severity of bleeding, the mother's overall condition, and available resources.

Arterial ligation with preservation of the spleen may be possible in selected cases, whereas splenectomy may be necessary in others.

3. Endovascular Treatment and Embolization

Endovascular embolization may be an option when the clinical circumstances permit, particularly when the patient is relatively stable and interventional radiology services are immediately available.

The procedure generally involves inserting a catheter into the blood vessels and using specialized materials, such as metal coils or embolic agents, to block the bleeding vessel or exclude the aneurysm from circulation.

Potential advantages include controlling bleeding without open surgery in selected cases. However, this approach is not suitable for every patient and must not delay life-saving surgery when bleeding remains uncontrolled or severe hemodynamic instability is present.

Third: Obstetric Considerations During Treatment

Managing splenic artery rupture during pregnancy requires coordination among the surgical team, obstetricians, and anesthesiologists, with neonatal specialists involved when necessary.

The decision to deliver the baby during surgical treatment or postpone delivery depends on several factors, including:

Gestational age and the fetus's potential for survival outside the uterus.
Maternal hemodynamic stability and the degree of bleeding control.
Fetal heart rate and overall clinical condition.
Whether an urgent obstetric intervention is necessary.

Not every case requires an immediate cesarean section. The priority is to control the bleeding and save the mother's life, while making obstetric decisions according to the clinical circumstances.

Fourth: Postoperative Care

After the bleeding has been controlled, the pregnant woman requires close monitoring in an intensive care unit or an appropriate monitored setting, depending on the severity of her condition.

Postoperative care includes:

Monitoring blood pressure, pulse, and hemoglobin levels.
Ensuring that bleeding has stopped and checking for surgical complications.
Correcting coagulation abnormalities and monitoring organ function.
Monitoring fetal well-being and the ongoing pregnancy according to the medical team's recommendations.
Discussing vaccinations and infection prevention if splenectomy was necessary.

Tips for Managing Splenic Artery Rupture During Pregnancy

Splenic artery rupture during pregnancy is a medical emergency requiring immediate intervention because severe internal bleeding can threaten the lives of both the mother and fetus.

Understanding the appropriate steps, from initial suspicion through recovery, can help reduce complications and improve the chances of survival.

First: First Aid When Rupture Is Suspected

1. Call Emergency Medical Services Immediately

Emergency services should be contacted without delay if sudden, severe abdominal pain develops, particularly when accompanied by dizziness, fainting, cold sweating, or pallor.

Do not wait for symptoms to improve or rely on scheduling a routine medical appointment. These signs may indicate dangerous internal bleeding.

2. Place the Pregnant Woman in a Safe, Comfortable Position

Help the woman lie down and avoid unnecessary movement until emergency services arrive.

In advanced pregnancy, a left lateral tilt may be used if it is comfortable and does not worsen breathing. Do not force the woman to stand or move around.

3. Avoid Food, Drinks, and Oral Medications

The patient may require anesthesia or emergency surgery. Therefore, avoid giving food, drinks, or oral medications until the medical team evaluates her, and follow the instructions provided by emergency personnel.

4. Monitor Consciousness and Breathing

Monitor the woman's level of consciousness and breathing until medical assistance arrives.

If she loses consciousness, check her breathing and follow the emergency dispatcher's instructions. If she is not breathing normally, begin cardiopulmonary resuscitation (CPR) according to emergency guidance and use an automated external defibrillator (AED) if available and indicated.

Second: Medical Management in the Hospital

Managing splenic artery rupture requires rapid collaboration among different medical teams. Essential measures include the following:

Immediate assessment and resuscitation: Monitor blood pressure, heart rate, respiratory rate, and oxygen saturation; establish intravenous access; and replace lost blood when necessary.
Necessary investigations: These include a complete blood count, blood typing and crossmatching, coagulation tests, and appropriate imaging based on the patient's stability.
Urgent bleeding control: This may involve surgery or endovascular intervention in suitable cases. Life-saving treatment must not be delayed.
Fetal assessment: Monitor the fetal heart rate and evaluate fetal well-being according to gestational age and maternal stability.
Multidisciplinary coordination: Involve general or vascular surgeons, obstetricians, anesthesiologists, and neonatologists when necessary.

Third: Practices to Avoid

To reduce potential risks, the following precautions are important:

Do not assume that severe abdominal pain is simply a normal pregnancy symptom.
Do not wait for a significant drop in blood pressure or loss of consciousness before seeking emergency care.
Do not delay necessary life-saving intervention to complete imaging tests that are not immediately essential.
Do not assume that temporary disappearance of pain means the bleeding has stopped.
Do not decide independently whether to perform or postpone a cesarean section without an assessment of maternal and fetal well-being by the specialist team.
Do not use medications or home remedies in an attempt to stop internal bleeding.

Fourth: Recovery and Follow-Up Care

After bleeding has been controlled, the pregnant woman requires careful medical follow-up to identify complications and support recovery.

Follow-up care includes:

Monitoring vital signs and hemoglobin levels and confirming that bleeding has stopped.
Assessing fetal well-being and continuation of the pregnancy according to the obstetric team's recommendations.
Following the doctor's instructions regarding movement, physical activity, and medication during recovery.
Discussing appropriate vaccinations and infection prevention if splenectomy was performed.
Attending follow-up appointments with the surgeon to confirm successful treatment and check for vascular or surgical complications.