Incidence, outcomes and management of spontaneous haemoperitoneum in pregnancy: a UK population-based study

TL;DR

Spontaneous haemoperitoneum in pregnancy (SHiP) is rare but can lead to severe complications for both mothers and babies, including high rates of preterm birth, neonatal intensive care, and maternal ICU admission.

Contribution

This study provides the first UK population-based incidence and outcomes data for SHiP, highlighting its rarity and severity.

Findings

SHiP occurs at an incidence of 1.3 cases per 100,000 maternities in the UK.

Perinatal outcomes are poor, with 16% stillbirth rate and high neonatal unit admission rates.

Maternal morbidity is significant, with 60% ICU admission and one maternal death reported.

Abstract

Spontaneous haemoperitoneum in pregnancy (SHiP) is the occurrence during pregnancy of sudden intra-abdominal haemorrhage unrelated to extrauterine pregnancy, trauma or uterine rupture. SHiP is uncommon but is associated with preterm birth, high perinatal mortality and, more rarely, maternal mortality. We investigated the incidence of SHiP in the UK and its diagnosis, management and outcomes.

This two-year, prospective surveillance study used the UK Obstetric Surveillance System to collect anonymous data on all women who gave birth in a UK consultant-led maternity unit in 2016 and 2017 and who experienced SHiP.

We confirmed 20 cases of SHiP, giving an estimated incidence of 1.3 cases per 100,000 maternities, or 1 per 75,614 maternities. The median gestational age at diagnosis was 35.7 weeks (IQR 29.9–38.4 weeks). A minority of affected women were receiving anticoagulant agents for prophylaxis (2/20) or treatment (4/20). The most common initial suspected diagnosis was placental abruption (7/20), followed by intra-abdominal bleeding, uterine rupture, or infection. SHiP was diagnosed using ultrasound in four women, using CT in five, and solely at surgery in 14. Aneurysms (4/20) and organ rupture or haematoma (5/20) were the most common bleeding source, and the condition was most commonly diagnosed and treated by laparotomy (11/20). Perinatal morbidity and mortality were high, with 16% of infants stillborn, an over 80% admission rate to the neonatal unit among the 16 live-born infants, major complications in a third of these infants, and one neonatal death. Maternal morbidity was also high, with 60% of women admitted to the intensive care unit, over half of whom experienced major morbidity, and one maternal death.

SHiP is rare in the UK but when it occurs, it can be associated with major maternal morbidity and mortality, and perinatal outcomes are poor. International comparisons are complicated by differing definitions of SHiP.

Spontaneous haemoperitoneum in pregnancy, or “SHiP”, is a rare but serious condition that can happen during pregnancy. It involves sudden internal bleeding into the belly that is not caused by an injury and does not come from the womb. We wanted to understand how common SHiP is in the UK, how women who experience it are diagnosed and treated, and what happens to them and their babies.

We worked with a national network of doctors and midwives who work in UK hospital maternity units to collect information for our study. They told us about every woman who gave birth in 2016 and 2017, and who experienced SHiP. In the two years of our study, about 1.5 million women gave birth in the UK. Of these, 20 women experienced SHiP – about one in 75,000. The most common symptom was belly pain. Over half of the women’s unborn babies’ heart rates were affected, and several women collapsed. A few women had an ultrasound or CT scan to diagnose the problem, but for most women, SHiP was diagnosed during surgery. Bleeding most often came from a burst blood vessel or damaged organ. SHiP was very dangerous for the women’s babies: three of the babies were stillborn and one died after birth. Most of the babies who survived needed to be cared for in the neonatal intensive care unit. SHiP was also very serious for the women themselves: one woman died, and over half needed treatment in the intensive care unit.

Our study showed that SHiP is very rare in the UK. However, when it does happen, in many cases it results in serious illness, and it can be fatal, for both mum and baby. Healthcare workers need to be alert for signs of SHiP.