[Spontaneous rupture of a splenic artery aneurysm during the third trimester of pregnancy]. / Rupture spontanée d'un anévrysme de l'artère splénique au cours du troisième trimestre de la grossesse.

We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it's important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.

Nous rapportons l'histoire d'une patiente de 24 ans ayant présenté une rupture spontanée d'un anévrysme de l'artère splénique au cours du troisième trimestre de la grossesse. Celle-ci, de par les changements physiologiques et hormonaux qu'elle impose, favorise la survenue de l'anévrysme de l'artère splénique et sa rupture. Bien qu'il s'agisse d'une complication rare, son pronostic est redoutable et le tableau clinique typique associant douleur abdominale, hypotension et anémie est trompeur pour le clinicien qui évoque, plus volontiers, un hématome rétroplacentaire ou une rupture utérine. La survie materno-fœtale dépend de la rapidité diagnostique et d'une prise en charge multidisciplinaire, raisons pour lesquelles il est important que le clinicien considère ce diagnostic différentiel lors de la survenue d'une douleur abdominale ou d'un hémopéritoine chez la femme enceinte, particulièrement durant le 3ème trimestre de la grossesse.

Variation of the maximum velocity along the umbilical vein supports the Reynolds pulsometer model.

OBJECTIVE: To challenge, with a modern sonographic approach and a numerical model, the Reynolds's concept which suggests that the vascular structure of the umbilical cord could act as a pulsometer facilitating the venous return to the foetus. METHOD: Forty-five patients between 20 and 28 weeks of gestation were included in the study. The blood maximum velocity in the umbilical vein, measured at both foetal and placental ends, was assessed. Several sonographic parameters of the cord, including the diameter of the umbilical vein at both extremities, cord cross-sectional area and Wharton's jelly section surface were measured. We compare our data with those of a numerical model. RESULTS: A difference in maximum velocity between the two extremities of the umbilical vein (ΔUVVmax) was noted. The maximum velocity was significantly higher at the foetal umbilical end (14.12 +/-3.18 cm/s) than at the placental end (11.93 +/-2.55 cm/s; p < 0.0001). The mean difference is 2.2 +/- 2.3 cm/s. No difference in the umbilical vein diameter was measured at both cord ends (umbilical 4.85 +/-0.9 mm, placental 4.86 +/-0.87 mm, p < 0.0001). There is no significant relationship between ΔUVVmax and the cord cross-sectional area or Wharton's jelly index. CONCLUSION: Modifications of the spatial velocity profile together with the pulsometer model could explain the maximum velocity changes that is measured in the umbilical vein along the cord. This numerical model consolidates the sonographic observations.