Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;130(13):1620-1628.
doi: 10.1111/1471-0528.17556. Epub 2023 Jun 6.

Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system

Anneke M F Schreurs #  1   2 , Evelien M Overtoom #  3 , Marjon A de Boer  2   4 , Lisette E E van der Houwen  1   2 , Marit C I Lier  1   2 , Thomas van den Akker  5   6 , Jerome Cornette  7 , Tatjana E Vogelvang  8 , Ingrid C M Beenakkers  9 , Ageeth N Rosman  10 , Jacques W M Maas  11 , David J Heineman  12 , Martijn J J Finken  2   13 , Jan J J de Vries  14 , Nicole B Burger  15 , Timme P Schaap  3 , Kitty W M Bloemenkamp  3 , Velja Mijatovic  1   2
Affiliations

Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system

Anneke M F Schreurs et al. BJOG. 2023 Dec.

Abstract

Objective: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP.

Design: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS).

Setting: Nationwide, the Netherlands.

Population: All pregnant women between April 2016 and April 2018.

Methods: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP.

Main outcome measures: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP.

Results: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention.

Conclusions: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

Keywords: ART; NethOSS; SHiP; endometriosis; fetal morbidity; maternal morbidity; obstetric surveillance system.

PubMed Disclaimer

References

REFERENCES

    1. Brosens IA, Fusi L, Brosens JJ. Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. Fertil Steril. 2009;92(4):1243-5.
    1. Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, et al. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG. 2019;126(3):394-401.
    1. Lier MCI, Malik RF, Ket JCF, Lambalk CB, Brosens IA, Mijatovic V. Spontaneous hemoperitoneum in pregnancy (SHiP) and endometriosis - a systematic review of the recent literature. Eur J Obstet Gynecol Reprod Biol. 2017;219:57-65.
    1. Schreurs A, Lier M, Koning D, Brals C, De Boer MA, Lambalk CB, et al. Severe psychological impact and impaired quality of life after a spontaneous haemoperitoneum in pregnancy in women with endometriosis and their partners. Facts Views Vis Obgyn. 2021;13(2):159-68.
    1. Hodgkinson CP, Christensen RC. Hemorrhage from ruptured utero-ovarian veins during pregnancy; report of 3 cases and review of the literature. Am J Obstet Gynecol. 1950;59(5):1112-7.

LinkOut - more resources