Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series

Objective To report pregnancy outcomes of SH iP (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 SH iP. Methods In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SH iP that occurred in the Netherlands between 2010 and 2015 were retrieved. Main outcome measures Maternal and perinatal mortality and morbidity. Results SH iP 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 SH iP. Four women showed recurrence of SH iP. In one of these cases the second event of SH iP occurred in a subsequent pregnancy. Conclusion Pregnancy outcomes of SH iP 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 SH iP is advocated, especially in women diagnosed with endometriosis.