Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth

Marit C I Lier, Ivo A Brosens, Velja Mijatovic, Marwan Habiba, Giuseppe Benagiano

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis.

METHODS: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological findings at the bleeding site with histological data was found in 24 case reports (16 pregnant, 8 postpartum).

RESULTS: Among pregnant women (81% primigravida), 75% had a diagnosis of endometriosis and 25% of deciduosis. Among postpartum women (38% primiparous), 63% had a diagnosis of deciduosis and 25% of endometriosis. In all cases except one, decidual cells, with or without glandular structures, were present at the bleeding site. Decidual vessels were described in 7 cases and all exhibited vascular changes, including distension of the lumen, medial disorganization, or loss of vascular integrity. These vessels were significantly different from arteries seen in the secretory endometrium, showing that structural modifications take place during the initial stage of the remodelling of placental bed spiral arteries.

CONCLUSIONS: During pregnancy, a link seems to exist between ectopic decidualization, particularly that occurring in endometriotic foci, and occurrence of SHiP. In addition, subclinical decidual bleeding may be a potential risk factor for preterm labour.

Original languageEnglish
Pages (from-to)313-321
Number of pages9
JournalGynecologic and Obstetric Investigation
Volume82
Issue number4
DOIs
Publication statusPublished - 2017

Cite this

Lier, Marit C I ; Brosens, Ivo A ; Mijatovic, Velja ; Habiba, Marwan ; Benagiano, Giuseppe. / Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth. In: Gynecologic and Obstetric Investigation. 2017 ; Vol. 82, No. 4. pp. 313-321.
@article{7a792d1897f443078423fdf686572081,
title = "Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth",
abstract = "BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis.METHODS: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological findings at the bleeding site with histological data was found in 24 case reports (16 pregnant, 8 postpartum).RESULTS: Among pregnant women (81{\%} primigravida), 75{\%} had a diagnosis of endometriosis and 25{\%} of deciduosis. Among postpartum women (38{\%} primiparous), 63{\%} had a diagnosis of deciduosis and 25{\%} of endometriosis. In all cases except one, decidual cells, with or without glandular structures, were present at the bleeding site. Decidual vessels were described in 7 cases and all exhibited vascular changes, including distension of the lumen, medial disorganization, or loss of vascular integrity. These vessels were significantly different from arteries seen in the secretory endometrium, showing that structural modifications take place during the initial stage of the remodelling of placental bed spiral arteries.CONCLUSIONS: During pregnancy, a link seems to exist between ectopic decidualization, particularly that occurring in endometriotic foci, and occurrence of SHiP. In addition, subclinical decidual bleeding may be a potential risk factor for preterm labour.",
keywords = "Journal Article",
author = "Lier, {Marit C I} and Brosens, {Ivo A} and Velja Mijatovic and Marwan Habiba and Giuseppe Benagiano",
note = "{\circledC} 2017 S. Karger AG, Basel.",
year = "2017",
doi = "10.1159/000468933",
language = "English",
volume = "82",
pages = "313--321",
journal = "Gynecologic and Obstetric Investigation",
issn = "0378-7346",
publisher = "S. Karger AG",
number = "4",

}

Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth. / Lier, Marit C I; Brosens, Ivo A; Mijatovic, Velja; Habiba, Marwan; Benagiano, Giuseppe.

In: Gynecologic and Obstetric Investigation, Vol. 82, No. 4, 2017, p. 313-321.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth

AU - Lier, Marit C I

AU - Brosens, Ivo A

AU - Mijatovic, Velja

AU - Habiba, Marwan

AU - Benagiano, Giuseppe

N1 - © 2017 S. Karger AG, Basel.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis.METHODS: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological findings at the bleeding site with histological data was found in 24 case reports (16 pregnant, 8 postpartum).RESULTS: Among pregnant women (81% primigravida), 75% had a diagnosis of endometriosis and 25% of deciduosis. Among postpartum women (38% primiparous), 63% had a diagnosis of deciduosis and 25% of endometriosis. In all cases except one, decidual cells, with or without glandular structures, were present at the bleeding site. Decidual vessels were described in 7 cases and all exhibited vascular changes, including distension of the lumen, medial disorganization, or loss of vascular integrity. These vessels were significantly different from arteries seen in the secretory endometrium, showing that structural modifications take place during the initial stage of the remodelling of placental bed spiral arteries.CONCLUSIONS: During pregnancy, a link seems to exist between ectopic decidualization, particularly that occurring in endometriotic foci, and occurrence of SHiP. In addition, subclinical decidual bleeding may be a potential risk factor for preterm labour.

AB - BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis.METHODS: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological findings at the bleeding site with histological data was found in 24 case reports (16 pregnant, 8 postpartum).RESULTS: Among pregnant women (81% primigravida), 75% had a diagnosis of endometriosis and 25% of deciduosis. Among postpartum women (38% primiparous), 63% had a diagnosis of deciduosis and 25% of endometriosis. In all cases except one, decidual cells, with or without glandular structures, were present at the bleeding site. Decidual vessels were described in 7 cases and all exhibited vascular changes, including distension of the lumen, medial disorganization, or loss of vascular integrity. These vessels were significantly different from arteries seen in the secretory endometrium, showing that structural modifications take place during the initial stage of the remodelling of placental bed spiral arteries.CONCLUSIONS: During pregnancy, a link seems to exist between ectopic decidualization, particularly that occurring in endometriotic foci, and occurrence of SHiP. In addition, subclinical decidual bleeding may be a potential risk factor for preterm labour.

KW - Journal Article

U2 - 10.1159/000468933

DO - 10.1159/000468933

M3 - Article

VL - 82

SP - 313

EP - 321

JO - Gynecologic and Obstetric Investigation

JF - Gynecologic and Obstetric Investigation

SN - 0378-7346

IS - 4

ER -