Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series

McI Lier, R F Malik, Jhtm van Waesberghe, J W Maas, D A van Rumpt-van de Geest, S F Coppus, J P Berger, B B van Rijn, P F Janssen, M A de Boer, Jip de Vries, F W Jansen, I A Brosens, C B Lambalk, V Mijatovic

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis.

DESIGN: Retrospective case note review.

SETTING: Dutch referral hospitals for endometriosis.

SAMPLE: Eleven women presenting with 15 events of SHiP.

METHODS: In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved.

MAIN OUTCOME MEASURES: Maternal and perinatal mortality and morbidity.

RESULTS: SHiP occurred predominantly in the second and third trimester of pregnancy. The earliest and major presenting symptom was an acute onset of abdominal pain, often combined with low haemoglobin levels or signs of fetal distress. Imaging was a diagnostic tool when free peritoneal fluid could be observed. For surgical treatment of the bleeding site, a midline laparotomy was mostly needed, the median estimated amount of blood loss was 2000 mL. No fetomaternal or perinatal mortality was reported, despite a high rate of preterm births (54.5%). In all women, endometriosis was diagnosed at a certain moment in time and therefore was probably involved in the pathogenesis of SHiP. Four women showed recurrence of SHiP. In one of these cases the second event of SHiP occurred in a subsequent pregnancy.

CONCLUSION: Pregnancy outcomes of SHiP are improving when compared with previous reports, with absent fetomaternal and perinatal mortality in this recent series. Growing knowledge and adequate multidisciplinary intervention may have contributed to these favourable results. Increasing awareness of this serious complication of pregnancy is advocated, especially in women diagnosed with endometriosis.

TWEETABLE ABSTRACT: Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.

Original languageEnglish
Pages (from-to)306-312
Number of pages7
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Volume124
Issue number2
DOIs
Publication statusPublished - Jan 2017

Cite this

Lier, McI ; Malik, R F ; van Waesberghe, Jhtm ; Maas, J W ; van Rumpt-van de Geest, D A ; Coppus, S F ; Berger, J P ; van Rijn, B B ; Janssen, P F ; de Boer, M A ; de Vries, Jip ; Jansen, F W ; Brosens, I A ; Lambalk, C B ; Mijatovic, V. / Spontaneous haemoperitoneum in pregnancy and endometriosis : a case series. In: BJOG: An International Journal of Obstetrics & Gynaecology. 2017 ; Vol. 124, No. 2. pp. 306-312.
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abstract = "OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis.DESIGN: Retrospective case note review.SETTING: Dutch referral hospitals for endometriosis.SAMPLE: Eleven women presenting with 15 events of SHiP.METHODS: In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved.MAIN OUTCOME MEASURES: Maternal and perinatal mortality and morbidity.RESULTS: SHiP occurred predominantly in the second and third trimester of pregnancy. The earliest and major presenting symptom was an acute onset of abdominal pain, often combined with low haemoglobin levels or signs of fetal distress. Imaging was a diagnostic tool when free peritoneal fluid could be observed. For surgical treatment of the bleeding site, a midline laparotomy was mostly needed, the median estimated amount of blood loss was 2000 mL. No fetomaternal or perinatal mortality was reported, despite a high rate of preterm births (54.5{\%}). In all women, endometriosis was diagnosed at a certain moment in time and therefore was probably involved in the pathogenesis of SHiP. Four women showed recurrence of SHiP. In one of these cases the second event of SHiP occurred in a subsequent pregnancy.CONCLUSION: Pregnancy outcomes of SHiP are improving when compared with previous reports, with absent fetomaternal and perinatal mortality in this recent series. Growing knowledge and adequate multidisciplinary intervention may have contributed to these favourable results. Increasing awareness of this serious complication of pregnancy is advocated, especially in women diagnosed with endometriosis.TWEETABLE ABSTRACT: Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.",
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author = "McI Lier and Malik, {R F} and {van Waesberghe}, Jhtm and Maas, {J W} and {van Rumpt-van de Geest}, {D A} and Coppus, {S F} and Berger, {J P} and {van Rijn}, {B B} and Janssen, {P F} and {de Boer}, {M A} and {de Vries}, Jip and Jansen, {F W} and Brosens, {I A} and Lambalk, {C B} and V Mijatovic",
note = "{\circledC} 2016 Royal College of Obstetricians and Gynaecologists.",
year = "2017",
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language = "English",
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Lier, M, Malik, RF, van Waesberghe, J, Maas, JW, van Rumpt-van de Geest, DA, Coppus, SF, Berger, JP, van Rijn, BB, Janssen, PF, de Boer, MA, de Vries, J, Jansen, FW, Brosens, IA, Lambalk, CB & Mijatovic, V 2017, 'Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series' BJOG: An International Journal of Obstetrics & Gynaecology, vol. 124, no. 2, pp. 306-312. https://doi.org/10.1111/1471-0528.14371

Spontaneous haemoperitoneum in pregnancy and endometriosis : a case series. / Lier, McI; Malik, R F; van Waesberghe, Jhtm; Maas, J W; van Rumpt-van de Geest, D A; Coppus, S F; Berger, J P; van Rijn, B B; Janssen, P F; de Boer, M A; de Vries, Jip; Jansen, F W; Brosens, I A; Lambalk, C B; Mijatovic, V.

In: BJOG: An International Journal of Obstetrics & Gynaecology, Vol. 124, No. 2, 01.2017, p. 306-312.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Spontaneous haemoperitoneum in pregnancy and endometriosis

T2 - a case series

AU - Lier, McI

AU - Malik, R F

AU - van Waesberghe, Jhtm

AU - Maas, J W

AU - van Rumpt-van de Geest, D A

AU - Coppus, S F

AU - Berger, J P

AU - van Rijn, B B

AU - Janssen, P F

AU - de Boer, M A

AU - de Vries, Jip

AU - Jansen, F W

AU - Brosens, I A

AU - Lambalk, C B

AU - Mijatovic, V

N1 - © 2016 Royal College of Obstetricians and Gynaecologists.

PY - 2017/1

Y1 - 2017/1

N2 - OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis.DESIGN: Retrospective case note review.SETTING: Dutch referral hospitals for endometriosis.SAMPLE: Eleven women presenting with 15 events of SHiP.METHODS: In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved.MAIN OUTCOME MEASURES: Maternal and perinatal mortality and morbidity.RESULTS: SHiP occurred predominantly in the second and third trimester of pregnancy. The earliest and major presenting symptom was an acute onset of abdominal pain, often combined with low haemoglobin levels or signs of fetal distress. Imaging was a diagnostic tool when free peritoneal fluid could be observed. For surgical treatment of the bleeding site, a midline laparotomy was mostly needed, the median estimated amount of blood loss was 2000 mL. No fetomaternal or perinatal mortality was reported, despite a high rate of preterm births (54.5%). In all women, endometriosis was diagnosed at a certain moment in time and therefore was probably involved in the pathogenesis of SHiP. Four women showed recurrence of SHiP. In one of these cases the second event of SHiP occurred in a subsequent pregnancy.CONCLUSION: Pregnancy outcomes of SHiP are improving when compared with previous reports, with absent fetomaternal and perinatal mortality in this recent series. Growing knowledge and adequate multidisciplinary intervention may have contributed to these favourable results. Increasing awareness of this serious complication of pregnancy is advocated, especially in women diagnosed with endometriosis.TWEETABLE ABSTRACT: Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.

AB - OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis.DESIGN: Retrospective case note review.SETTING: Dutch referral hospitals for endometriosis.SAMPLE: Eleven women presenting with 15 events of SHiP.METHODS: In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved.MAIN OUTCOME MEASURES: Maternal and perinatal mortality and morbidity.RESULTS: SHiP occurred predominantly in the second and third trimester of pregnancy. The earliest and major presenting symptom was an acute onset of abdominal pain, often combined with low haemoglobin levels or signs of fetal distress. Imaging was a diagnostic tool when free peritoneal fluid could be observed. For surgical treatment of the bleeding site, a midline laparotomy was mostly needed, the median estimated amount of blood loss was 2000 mL. No fetomaternal or perinatal mortality was reported, despite a high rate of preterm births (54.5%). In all women, endometriosis was diagnosed at a certain moment in time and therefore was probably involved in the pathogenesis of SHiP. Four women showed recurrence of SHiP. In one of these cases the second event of SHiP occurred in a subsequent pregnancy.CONCLUSION: Pregnancy outcomes of SHiP are improving when compared with previous reports, with absent fetomaternal and perinatal mortality in this recent series. Growing knowledge and adequate multidisciplinary intervention may have contributed to these favourable results. Increasing awareness of this serious complication of pregnancy is advocated, especially in women diagnosed with endometriosis.TWEETABLE ABSTRACT: Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.

KW - Journal Article

U2 - 10.1111/1471-0528.14371

DO - 10.1111/1471-0528.14371

M3 - Article

VL - 124

SP - 306

EP - 312

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

SN - 1470-0328

IS - 2

ER -