Images in clinical medicine | Volume 36, Article 98, 16 Jun 2020 | 10.11604/pamj.2020.36.98.22790

An unusual diagnosis of hemorrhage during third trimester

Mounir Moukit, Jaouad Kouach

Corresponding author: Mounir Moukit, Department of Obstetrics and Gynecology, Military Training Hospital Mohammed V, Rabat, Morocco

Received: 11 Apr 2020 - Accepted: 21 Apr 2020 - Published: 16 Jun 2020

Domain: Obstetrics and gynecology

Keywords: Hemorrhage, angiofibroma, pregnancy

©Mounir Moukit et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Mounir Moukit et al. An unusual diagnosis of hemorrhage during third trimester. Pan African Medical Journal. 2020;36:98. [doi: 10.11604/pamj.2020.36.98.22790]

Available online at: https://www.panafrican-med-journal.com/content/article/36/98/full

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Images in clinical medicine

An unusual diagnosis of hemorrhage during third trimester

An unusual diagnosis of hemorrhage during third trimester

Mounir Moukit1,&, Jaouad Kouach1

 

1Department of Obstetrics and Gynecology, Military Training Hospital Mohammed V, Rabat, Morocco

 

 

&Corresponding author
Mounir Moukit, Department of Obstetrics and Gynecology, Military Training Hospital Mohammed V, Rabat, Morocco

 

 

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A 33-year-old multiparous woman, presented for the first time in our department, at 39 weeks gestation, with the chief complaint of spontaneous vaginal bleeding appeared 6 hours before. There was no abdominal pain, uterine contractions and the bleeding was moderate in amount. She had only a third-trimester ultrasound with normal placental insertion site. On general examination, she was afebrile with normal vital signs. Obstetrical examination revealed fundal height corresponding to gestational age without uterine tenderness or rigidity. Fetal heart rate was normal. Vaginal examination revealed a well-circumscribed vascular mass arising from the posterior vaginal wall. A differential diagnosis of benign vaginal tumours (leiomyoma, angiomyofibroblastoma and cellular angiofibroma) or aggressive vaginal tumours was made. Under spinal anesthesia, caesarean section was performed followed (using lithotomy position) by a circular incision around the lesion with clear margins forcing enucleation of the mass; the wound was repaired with No. 0 monocryl sutures. The histopathologic report was vaginal angiofibroma. The postoperative course was uneventful and no recurrence was noted during a follow-up period of 3 years. Despite its rarity, vaginal angiofibroma should be considered in the differential diagnosis of antepartum haemorrhage.

 

 

Figure 1: A) vulvoperineal examination objectified the vaginal mass measuring 3cm x 4cm with vaginal discharge; B) spindle and stellate shaped tumour cells with many prominent blood vessels in a fibrous stroma (hematoxylin and eosin x 100)

 

 

 

 

Images in clinical medicine

An unusual diagnosis of hemorrhage during third trimester

Images in clinical medicine

An unusual diagnosis of hemorrhage during third trimester

Images in clinical medicine

An unusual diagnosis of hemorrhage during third trimester