Rectus sheath hematoma in pregnancy: a case report with literature review

Rectus sheath hematoma (RSH) is a rare cause of abdominal pain during pregnancy. In our case, a healthy pregnant woman presented with right upper abdominal pain at 33 weeks of gestation. Ultrasound showed a heterogeneous hypoechoic mass in the abdominal wall, which was suspected of being a rectus sheath hematoma. After half a day of conservative therapy, the progressive decrease in hemoglobin level suggested active bleeding into her rectus sheath. Consequently, surgery was initiated under general anesthesia. During the operation, we found that the right musculus rectus abdominis was ruptured and actively bleeding. The hematoma was removed, and the broken end of the bleeding rectus abdominis muscle was ligated. After the operation, a blood transfusion was given, and the patient was discharged from the hospital as scheduled. A healthy newborn was delivered by elective cesarean section at 39 weeks of gestation. We present this case to enhance the recognition of RSH during pregnancy. Although relatively rare, this condition manifests itself with an acute onset and severe symptoms. Timely and accurate diagnosis and management may effectively reduce the incidence of preterm delivery.