[DIAGNOSIS AND TREATMENT OF PREGNANT PATIENTS WITH SPLENIC ARTERY ANEURYSM (SAA) IN THE STATE OF ISRAEL: TWO DECADES OF EXPERIENCE AND STILL IT IS A MYSTERY].

Abstract

Introduction: Rupture of splenic artery aneurysm (SAA) during pregnancy or the puerperium is an obstetric emergency endangering the lives of both the pregnant patient and the fetus.

Aims: The aim of the current study is to characterize early signs of rupture SAA and recommend optimal management to prevent maternal and fetal mortality.

Methods: We conducted a retrospective follow-up study of cases reported in Israel among women diagnosed with SAA during pregnancy and postpartum. Demographics and obstetrical data of maternal and fetal/newborn were collected.

Results: We identified 13 cases of SAA in Israel between 2010 and 2023. The timing of the diagnosis ranged from the second to the third trimester (no cases were reported in the first trimester), with 2 cases diagnosed in the post-partum period. Three women (23%) died, and three fetuses did not survive (23%).

Conclusions: Rupture of SAA during the pregnancy or in the puerperium is a rare event, however, it is associated with maternal and neonatal mortality. Raising awareness among all healthcare providers to the possible diagnosis of rupture of SAA in pregnant or peri-partum women with nonspecific symptoms, including abdominal pain and hemodynamic deterioration, is crucial for decision making and management of those cases and possibly saving their lives and the lives of their fetuses.

Discussion: In cases presented with undefined symptoms, including abdominal pain and hemodynamic deterioration, the clinician should suspect SAA. Awareness to the possible clinical presentation of SAA rupture during pregnancy is crucial and may prevent mortality for both the pregnant patient and her fetus.