Lier MCI, et al. - A systematic review of the recent literature is done to assess the clinical consequences of Spontaneous Hemoperitoneum in Pregnancy (SHiP) and its relationship with endometriosis, according to the PRISMA guidelines. The outcome of this study suggests that the SHiP is a very serious complication of pregnancy, highly connected with adverse pregnancy outcomes and especially relevant to women with endometriosis. Currently, preventive measures are lacking, therefore increasing the awareness and recognition of SHiP is vital to improving pregnancy outcomes.

Methods

• For this study, they designed a systematic review.
• They searched PubMed, Embase.com and Thomson Reuters/Web of Science for articles published since the latest review (August 2008) until September 2016.

Results

• After assessment for eligibility, forty-four articles were incorporated into this systematic review, depicting 59 cases of SHiP.
• Endometriosis was present in 33/59 cases (55.9%), most often diagnosed prior to pregnancy.
• A relationship between the severity of SHiP and the stage of endometriosis could not be found.
• In the majority of cases, SHiP occurred in the third trimester of pregnancy (30/59 cases (50.8%)); women presented with (sub)acute abdominal pain (56/59 cases (94.9%)), hypovolemic shock (28/59 cases (47.5%)) and/or a reduced level of hemoglobin (37/59 cases (62.7%)).
• Signs of fetal distress were seen in 24/59 cases (40.7%).
• Imaging confirmed free peritoneal fluid in (37/59 cases (62.7%)).
• At time of surgery active bleeding was uncovered in 51/56 cases (91,1%), originating from endometriotic implants (11/51 cases (21.6%)), ruptured utero-ovarian vessels (29/51 cases (56.8%)), hemorrhagic nodules of decidualized cells (1/51 cases (2.0%)) or a combination (10/51 cases (19.6%)).
• Median amount of hemoperitoneum was 1600 mL (IQR 1000mL-2500 mL).
• From the 45/59 cases (76.3%) in which surgical interventions was carried out amid pregnancy, 7/45 cases (15.6%) reported a successful continuation of pregnancy.
• 5/59 cases reported recurrence of SHiP (recurrence rate 8.5%).
• The perinatal mortality rate was 26.9% (18/67 fetus), one maternal death was reported (1/59 cases (1,7%)).