Case report

A 29 years-old primigravida presented at 18+6 weeks of pregnancy (biometry equivalent to 19+4 weeks). Two days earlier she had left the hospital, in which she had been hospitalized because of a suspicion of premature rupture of membranes. She had been taken to the hospital because she had reported passing a moderate amount of yellowish-watery discharge from the vagina. Ultrasound revealed a subamniotic hematoma situated above the internal cervical os, with some internal medium intensity echoes, which most probably represented a clot. The internal cervical os was closed and the length of the cervical canal was normal. The amount of the amniotic fluid was normal.

In our opinion the mechanism of the signs presented by the patient was as follows: there was a subamniotic hemorrhage and a hematoma formed encroaching on the internal cervical os, with the retracted clot separated from the serum. The hematoma, with the solid and the fluid part was closed between the amnion and the decidua until the moment when the fluid from the hematoma found its way through the cervical canal into the vagina, what was interpreted as PROM. Naturally this is only a supposition, and we cannot rule out the possibility that there was a transitory rupture of the membranes, which sealed spontaneously. Such possibility seems to us less probable, though. At present there are no signs of amniotic fluid leakage.

Image 1, 2: 2D ultrasound scans showing subamniotic hematoma in supracervical region of the uterus.

Video 1, 2: 2D ultrasound scans showing subamniotic hematoma in supracervical region of the uterus.

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