Ectopic decidualization causing massive postpartum intraperitoneal Hemorrhage

Background: Spontaneous intraperitoneal hemorrhage during pregnancy or in the postpartum period is a rare but dangerous phenomenon. Case: A 41 -year-old gravida 3 para 1, 9 days postpartum, presented with lower abdominal pain and hypovolemia. Emergent laparotomy revealed massive intraperitoneal hemorrhage caused by ectopic decidualization with vascular intrusion into the left hypogastric artery in an area of previously documented endometriosis. Conclusion: Ectopic deciduosis is usually no more than a pathologic curiosity. In a pregnant patient with spontaneous intraperitoneal hemorrhage, however, it must be considered because it results in a high incidence of maternal and neonatal mortality.