Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System
Schreurs, Anneke M F; Overtoom, Evelien M; de Boer, Marjon A; van der Houwen, Lisette E E; Lier, Marit C I; van den Akker, Thomas; Cornette, Jerome; Vogelvang, Tatjana E; Beenakkers, Ingrid C M; Rosman, Ageeth N; Maas, Jacques W M; Heineman, David J; Finken, Martijn J J; de Vries, Jan J J; Burger, Nicole B; Schaap, Timme P; Bloemenkamp, Kitty W M; Mijatovic, Velja
(2023) BJOG - An International Journal of Obstetrics and Gynaecology, volume 130, issue 13, pp. 1620 - 1628
(Article)
Abstract
OBJECTIVE: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. DESIGN: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). SETTING: Nationwide, the Netherlands. POPULATION: All pregnant women between April 2016 and April
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2018. METHODS: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. MAIN OUTCOME MEASURES: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. RESULTS: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. CONCLUSIONS: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.
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Keywords: ART, endometriosis, fetal morbidity, maternal morbidity, NethOSS, obstetric surveillance system, SHiP, Obstetrics and Gynaecology, Journal Article
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Publisher Copyright: © 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
(Peer reviewed)