Endometriosis-related spontaneous hemoperitoneum in the early second trimester: A case report

Li-min, Huang; Hsu, Pei Yang; Chiang, Chun Ting; Chen, Hui-Wen; Wu, Meng Hsing

doi:10.1016/j.tjog.2021.01.032

Cited by 13 publications

(30 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Also, they showed a latency time between the first onset of symptoms and the definitive diagnosis, spanning from a few hours (cases n.III, VI) to several weeks (cases n.II, IV, V), which likely led to progressive worsening of the maternal clinical status. Other authors reported similar features in their cases, 5,11,12 with a latency time ranging from 2 h 5 to 5 days. 11 Yet, prompt diagnosis during this latency time before massive hemoperitoneum occurs is essential to avoid catastrophic outcomes and, in some cases, allow conservative management.…”

Section: Discussionsupporting

confidence: 66%

“…Other authors reported similar features in their cases, 5,11,12 with a latency time ranging from 2 h 5 to 5 days. 11 Yet, prompt diagnosis during this latency time before massive hemoperitoneum occurs is essential to avoid catastrophic outcomes and, in some cases, allow conservative management. 5 However, management of SHiP depends mainly on clinical presentation and gestational age at diagnosis.…”

Section: Discussionsupporting

confidence: 66%

See 1 more Smart Citation

Endometriosis‐related spontaneous hemoperitoneum in pregnancy: A case series

Bazzurini

Ornaghi

Colciago

et al. 2022

J of Obstet and Gynaecol

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Discussionsupporting

confidence: 66%

Endometriosis‐related spontaneous hemoperitoneum in pregnancy: A case series

Bazzurini

Ornaghi

Colciago

et al. 2022

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…Moreover, during pregnancy, the blood flow via the uterus increases, and the proliferative vessels become hypertrophic and fragile. Along with or without triggering factors changing the abdominal pressure, a sudden rupture of dilated subserosal vessels originating from endometriotic implants causes SHiP [ 10 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the symptoms of SHiP could also be overlapped and the diagnosis was made intraoperatively owing to caesarean section following fetal distress or other indications [ 3 ]. Furthermore, the symptoms may also be mimicked with acute peritonitis, thus a delayed surgical intervention made the situation worsen [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…An active site of bleeding from the left uterine artery branch with blood pulsating Not found General malaise, worsening abdominal pain, and hemorrhagic shock Drop in Hb levels US revealed an echogenic image with 95 × 88 × 53 mm suggestive of a blood clot on the pouch of Douglas Immediate evaluation of the CT scan images revealed haemoperitoneum Exploratory laparotomy and hemostasis Survival EBL was 2000 mL. Intraoperatively, the patient was resuscitated with 1600 mL of crystalloids, 4 units of erythrocyte concentrate, 3 units of FFP, 2 g of fibrinogen, and 1 g of tranexamic acid Pulmonary thromboembolism on the 15th day of postoperation Huang et al (2021) [ 12 ] 18 weeks Bleeding from decidualized endometriotic tissue over posterior uterine surface Endometriosis Diffuse lower abdominal pain, signs of peritoneal irritation, and abrupt deterioration with maternal shock Emergent laparotomy and multiple hemostatic sutures EBL at 1500 ml The patient recovered smoothly Stillbirth The present case 1 21–22 weeks Ruptured vessels and laceration on the serosal surface of the uterus Abnormal vascular proliferation of adenomyosis and endometriosis Abdominal tenderness, shoulder pain, hypovolemic shock Dropped Hb level US revealed a large amount of free fluid in abdominal cavity Exploratory laparotomy and hemostasis EBL at 2000 ml 4 units of packed RBC Maternal survival with uterine conservation Very preterm birth on the 4th postoperative day The present case 2 34 weeks 3 days Spontaneous rupture of vessels eroding into utero-ovarian plexus Abnormal proliferation of utero-ovarian plexus and adhesions from previously ovarian tumor resection Abdominal pain Low Hb levels US showed free fluid collection in abdominal cavity extended to hepatic and renal space Exploratory laparotomy, CS, releasing adhesion, vessel ligation and hemostasis EBL at 1200 ml 2 units of packed RBC The patient was alive and the uterus was preserved Preterm delivery with a live newborn CS caesarean section, CT computed tomography, EBL estimated blood loss, IOL induction of labor, GA gestational age, Hb hemoglobin, Hct hematocrit, FFP fresh frozen plasma, RBCs red blood cells, US ultrasound …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Vuong

Pham²,

Nguyen

et al. 2023

Int J Emerg Med

View full text Add to dashboard Cite

Background Spontaneous hemoperitoneum in pregnancy (SHiP) refers to fluid collection in the abdominal cavity with a vague presentation of clinical symptoms. Particularly, SHiP causes a life-threatening condition with the coexistence of intrauterine pregnancy, since this dangerous complication significantly increases the maternal and fetal mortality. Herein, we present two cases of nontraumatic SHiP in the second and third trimester of pregnancy, respectively. Case presentation The pregnant woman in case 1 was admitted to our hospital owing to severe paroxysmal shoulder pain along with abdominal pain. Her medical history was remarkably recorded with endometriosis and adenomyosis. At the emergency room, an ultrasound scan revealed a live fetus corresponding to 21 weeks and 3 days and free fluid in the abdominal cavity. She was subsequently diagnosed with SHiP and underwent immediate laparotomy for hemostatic procedures. During the postpartum course, the patient was uneventfully monitored. Unfortunately, the patient delivered on the 4th postoperative day in spite of the initial administration of tocolytic agents and close monitoring. The primigravid woman in case 2 complained of lower abdominal pain and vaginal bleeding. The patient’s history was noted with ovarian tumor removal. At admission, the sonography scan revealed free fluid in the abdominal cavity, a fetus at 34 weeks and 3 days gestational age with bradycardia of 70 bpm, and a laboratory test showed a low hemoglobin level. Thus, exploratory laparotomy and hysterotomy were performed at the same time due to fetal distress. The postpartum course was uneventful. The patient was discharged 5 days later. Conclusions In pregnant women with a history of endometriosis, adenomyosis, or ovarian tumor removal, acute abdominal pain combined with the presence of free fluid collection in the intraperitoneal cavity, and a decreased hemoglobin levels should be first assessed as SHiP originating from the spontaneous rupture of abnormal vascular proliferation. Proper management is strongly indicated for an emergent laparotomy to control the active bleeding point, thus increasing the survival rate for both mother and neonate.

show abstract

Spontaneous hemoperitoneum in a 29‐week pregnancy with a history of endometriosis: A case report and review of the literature

Mehdiyev,

Tanoglu,

Altuncu

et al. 2024

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Spontaneous hemoperitoneum in pregnancy (SHIP) is defined as sudden, nontraumatic intraperitoneal bleeding that occurs during pregnancy or up to 42 days postpartum. The incidence ranges between 4 and 4.9 per 100 000 births. Although seen rarely, it is associated with perinatal morbidity and mortality due to maternal hemodynamic instability. Endometriosis was shown to be present in 71% of SHIP cases. A 30‐year‐old primigravid woman with a spontaneous conception, at 29 weeks of gestation, presented to our obstetrics and gynecology emergency department with complaints of abdominal and back pain. In terms of her medical history, a laparoscopic cystectomy was performed in August 2022 due to a 90 mm × 50 mm endometrioma in the right ovary. However, deep endometriosis and adenomyosis were not observed. After decelerations appeared on the non‐stress test, the repeat hemoglobin values dropped to 7.2 g/dL, with blood pressure at 70/50 mm Hg and a pulse rate of 95/min. The decision was made for laparotomy and emergency delivery of the baby. It is crucial to consider SHIP, especially in pregnant patients with a history of endometriosis surgery. Managing such high‐risk cases in specialized centers and easily identifying predisposing factors for SHIP can lead to improved outcomes, despite its rarity and poor prognosis.

show abstract

Endometriosis-related spontaneous hemoperitoneum in the early second trimester: A case report

Cited by 13 publications

References 8 publications

Endometriosis‐related spontaneous hemoperitoneum in pregnancy: A case series

Endometriosis‐related spontaneous hemoperitoneum in pregnancy: A case series

Spontaneous hemoperitoneum in the second and third trimester of pregnancy: two uncommon case reports at Tu Du Hospital, in Vietnam and a literature review

Spontaneous hemoperitoneum in a 29‐week pregnancy with a history of endometriosis: A case report and review of the literature

Contact Info

Product

Resources

About