title: Severe spontaneous hemoperitoneum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review.
abstract: OBJECTIVE
  To evaluate existing evidence of a possible association in women with endometriosis between controlled ovarian hyperstimulation plus embryo transfer (COH-ET) and the occurrence of spontaneous hemoperitoneum in pregnancy (SHiP).
  
  
  METHODS
  Comprehensive review.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  None.
  
  
  METHODS
  An electronic literature search up to February 2016 was conducted using Scopus and PubMed.
  
  
  METHODS
  The role of COH-ET in SHiP.
  
  
  RESULTS
  Controlled ovarian hyperstimulation plus embryo transfer may increase the severity or incidence of the rare condition known as SHiP. An analysis of published cases shows that bleeding often occurs from multiple or diffuse sites, mainly situated in the posterior pelvic cavity, making it difficult to control without interfering with the pregnancy itself. Spontaneous hemoperitoneum in pregnancy is linked to adverse perinatal outcomes, including stillbirth, neonatal mortality, and very low or low birth weight. In 14 cases a biopsy of the bleeding site was obtained, and in all cases, even in the absence of visible endometriosis, decidualization was documented. At present, the relatively small number of cases published prevents firm conclusions, although they are highly suggestive of a link between COH-ET in women with endometriosis and the occurrence and seriousness of SHiP.
  
  
  CONCLUSIONS
  Spontaneous hemoperitoneum in pregnancy is a rare but potentially fatal complication for the pregnant woman and her unborn child. In vitro fertilization in women with severe endometriosis may be a risk factor for SHiP.
authors.affiliation: Leuven Institute for Fertility and Embryology, Leuven, Belgium. Electronic address: ivo.brosens@med.kuleuven.be.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Brosens
authors.affiliation: Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Marit C
authors.initials: MC
authors.lastname: Lier
authors.affiliation: Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Velja
authors.initials: V
authors.lastname: Mijatovic
authors.affiliation: Department of Obstetrics and Gynecology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom.
authors.forename: Marwan
authors.initials: M
authors.lastname: Habiba
authors.affiliation: Department of Gynecology, Obstetrics, and Urology, Sapienza, University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Benagiano
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ectopic deciduosis; IVF; endometriosis; progesterone; spontaneous hemoperitoneum in pregnancy