Maternal Mortality Secondary to Undiagnosed Intestinal Obstruction in the Third Trimester of Pregnancy: A Case Report

Pregnancy is a time of profound physical change, where the body adapts to nurture a growing life. Yet, these same adaptations can sometimes hide a different kind of danger: a sudden, life-threatening illness that has nothing to do with the pregnancy itself. When a pregnant woman experiences severe abdominal pain, doctors face a difficult puzzle. The symptoms of a surgical emergency, such as a blocked intestine, often look exactly like the discomforts of late pregnancy or other obstetric crises, like the placenta separating from the uterus. Because the uterus pushes against the internal organs and hormones slow down the digestive system, the usual signs of a blockage become muffled or misleading. This diagnostic confusion is dangerous. If a surgeon does not intervene quickly to fix a blocked bowel, the tissue can die, leading to infection and organ failure. The challenge is to look past the obvious pregnancy-related explanations and find the hidden surgical problem before it is too late.

This case report tells the story of a 28-year-old woman in Ethiopia who arrived at a hospital in the final weeks of her pregnancy, suffering from four days of worsening pain, vomiting, and an inability to pass gas or stool. Her condition was critical. By the time she reached the medical team, she was in shock, with a rapid heart rate and low blood pressure. The initial assessment pointed toward a tragic obstetric emergency: the baby had died in the womb, likely due to the placenta separating prematurely. The presence of bloody fluid in the vagina and the rigid, tender abdomen strongly suggested this was a pregnancy-related catastrophe. However, the speed at which her condition deteriorated hinted that something else was happening inside her belly. The medical team performed an emergency surgery, opening the abdomen to find the true cause.

Inside, the surgeons discovered that the woman's small intestine was not just blocked, but had become gangrenous, meaning the tissue had died from lack of blood flow. The cause was a rare condition called intussusception, where one part of the intestine slides inside another, much like a telescope collapsing. In this specific case, a section of the lower small intestine had telescoped into the beginning of the large intestine. This blockage had caused the bowel to swell massively, stretching the abdomen and cutting off blood supply to a large portion of the gut. The surgeons found no tumor or other physical object that had triggered this sliding; it appeared to be a spontaneous event caused by the unique pressures of late pregnancy. The enlarged uterus had pushed the intestines into a crowded space, while pregnancy hormones had slowed their movement, creating a perfect storm for the bowel to fold in on itself.

Despite the team's rapid efforts, the outcome was heartbreaking. The woman had been symptomatic for four days before receiving tertiary care, a delay that allowed the bowel to die completely. During the surgery, the team delivered the stillborn baby and attempted to stabilize the mother, but the damage was already done. The dead bowel tissue had released toxins that triggered a massive, uncontrollable infection throughout her body, known as septic shock. Her organs began to fail one by one, and despite aggressive support with fluids, blood products, and medication to keep her heart beating, she passed away shortly after the operation. The placenta was delivered manually during the surgery and appeared grossly normal, with no evidence of retroplacental hematoma, proving that the initial suspicion of a placental separation was incorrect and that the true cause of death was the undiagnosed bowel obstruction.

This tragic event highlights a critical lesson for medical care: when a pregnant woman presents with severe abdominal pain and vomiting, doctors must consider surgical emergencies even if the signs point to an obstetric problem. The symptoms of a blocked bowel can mimic the pain of labor or placental issues, leading to a dangerous delay in treatment. In this case, the bloody fluid and the death of the baby were misleading clues that distracted from the real problem. The authors suggest that medical teams need a higher level of suspicion for non-pregnancy-related causes of pain, especially when the pain is severe and persistent. They recommend that if standard ultrasound scans cannot clearly show what is wrong, doctors should not hesitate to use advanced imaging, such as magnetic resonance imaging or low-dose computed tomography, to find the blockage early. The risk of radiation from a scan is far smaller than the risk of losing a mother and child to a missed diagnosis. This case serves as a somber reminder that in the complex landscape of late pregnancy, the most obvious answer is not always the right one, and swift, thorough investigation is essential to save lives.