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

TL;DR

A rare case of spontaneous abdominal bleeding during pregnancy is reported in a woman with a history of endometriosis.

Contribution

This case highlights the importance of considering spontaneous hemoperitoneum in pregnant patients with endometriosis history.

Findings

Endometriosis was present in 71% of SHIP cases previously reported.

Emergency delivery was required due to maternal hemodynamic instability at 29 weeks gestation.

SHIP should be considered in pregnant patients with a history of endometriosis surgery.

Abstract

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.

Spontaneous hemoperitoneum should be kept in mind as an acute event associated with maternal–fetal mortality and morbidity among endometriosis‐associated complications in pregnancy.