Endometriosis‐related spontaneous hemoperitoneum in pregnancy: A case series

Abstract

Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosisrelated spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes.

Endometriosis-associated spontaneous major haemoperitoneum in pregnancy

“…In conclusion, our case highlights a rare but potentially catastrophic clinical presentation in pregnancy 1 7–9. SHiP has been associated with a number of causes including endometriosis 5.…”

Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system

“…An advantage of CT is the ability to determine the most likely origin of the haemorrhage. The fetal exposure to radiation during CT is estimated at 9 mGy, which is below the advised maximum allowed dose for fetuses 33,38 …”

“…The fetal exposure to radiation during CT is estimated at 9 mGy, which is below the advised maximum allowed dose for fetuses. 33,38 This was the first study on nationwide obstetric complications that used an online DAS. Overall, the audit panel was satisfied with the use of the DAS.…”

Spontaneous haemoperitoneum in pregnancy in women with endometriosis: Diagnostic challenges and management strategies

“…A large multicentre prospective cohort study 8 completed in Italy reported an incidence of 0.04/1000 births. Bazurini et al 1 reported a case series of six patients over 13 years with an estimated prevalence of 1.7/10,000 births. This literature review highlights the limited available evidence on this topic and the need for further research to enhance our understanding of the underlying mechanisms, risk factors and optimal management strategies.…”

“…Spontaneous haemoperitoneum is uncommon during pregnancy, and its association with endometriosis further adds to the complexity of the condition. 1 , 2 SHiP is spontaneous, non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days after delivery requiring surgical intervention or embolisation, not due to uterine rupture, ruptured ectopic pregnancies, or caesarean section-related bleeding. 2 , 3 SHiP has been described in the setting of ruptured uterine arteries, varicose veins or aneurysms of the splenic artery, but causes due to endometriosis are increasingly reported in the literature.…”