title: Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series.
abstract: OBJECTIVE
  To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis.
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Dutch referral hospitals for endometriosis.
  
  
  METHODS
  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  In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.
authors.affiliation: Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands.
authors.forename: McI
authors.initials: M
authors.lastname: Lier
authors.affiliation: Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands.
authors.forename: R F
authors.initials: RF
authors.lastname: Malik
authors.affiliation: Department of Radiology, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands.
authors.forename: Jhtm
authors.initials: J
authors.lastname: van Waesberghe
authors.affiliation: Department of Obstetrics & Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Maas
authors.affiliation: Department of Obstetrics & Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands.
authors.forename: D A
authors.initials: DA
authors.lastname: van Rumpt-van de Geest
authors.affiliation: Department of Obstetrics & Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: S F
authors.initials: SF
authors.lastname: Coppus
authors.affiliation: Department of Obstetrics & Gynaecology, Bronovo Hospital, Den Haag, the Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Berger
authors.affiliation: Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.|Academic Unit Human Development and Health, Institute for Life Sciences, University of Southampton, Southampton, UK.
authors.forename: B B
authors.initials: BB
authors.lastname: van Rijn
authors.affiliation: Department of Obstetrics & Gynaecology, St. Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: P F
authors.initials: PF
authors.lastname: Janssen
authors.affiliation: Department of Obstetrics & Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: de Boer
authors.affiliation: Department of Obstetrics & Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: Jip
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Obstetrics & Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
authors.affiliation: Leuven Institute for Fertility and Embryology, Leuven, Belgium.
authors.forename: I A
authors.initials: IA
authors.lastname: Brosens
authors.affiliation: Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands.
authors.forename: C B
authors.initials: CB
authors.lastname: Lambalk
authors.affiliation: Department of Reproductive Medicine, VU University Medical Centre, Endometriosis Centre VUmc, Amsterdam, the Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Mijatovic
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D004715:Endometriosis / Q000150:complications*; D005260:Female; D005316:Fetal Distress / Q000209:etiology; D006465:Hemoperitoneum / Q000209:etiology*; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology; D012189:Retrospective Studies
keywords: Bleeding; endometriosis; haemoperitoneum; infertility; peritoneal disorders; pregnancy