TY - JOUR
T1 - Spontaneous Haemoperitoneum in Pregnancy
T2 - Nationwide Surveillance and Delphi Audit System
AU - Schreurs, Anneke M. F.
AU - Overtoom, Evelien M.
AU - de Boer, Marjon A.
AU - van der Houwen, Lisette E. E.
AU - Lier, Marit C. I.
AU - van den Akker, Thomas
AU - Cornette, Jerome
AU - Vogelvang, Tatjana E.
AU - Beenakkers, Ingrid C. M.
AU - Rosman, Ageeth N.
AU - Maas, Jacques W. M.
AU - Heineman, David J.
AU - Finken, Martijn J. J.
AU - de Vries, Jan J. J.
AU - Burger, Nicole B.
AU - Schaap, Timme P.
AU - Bloemenkamp, Kitty W. M.
AU - Mijatovic, Velja
PY - 2023/12
Y1 - 2023/12
N2 - 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 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.
AB - 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 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.
KW - ART
KW - endometriosis
KW - fetal morbidity
KW - maternal morbidity
KW - NethOSS
KW - obstetric surveillance system
KW - SHiP
KW - ENDOMETRIOSIS
KW - RUPTURE
KW - IMPACT
KW - WOMEN
U2 - 10.1111/1471-0528.17556
DO - 10.1111/1471-0528.17556
M3 - Article
C2 - 37280664
SN - 1470-0328
VL - 130
SP - 1620
EP - 1628
JO - Bjog-an International Journal of Obstetrics and Gynaecology
JF - Bjog-an International Journal of Obstetrics and Gynaecology
IS - 13
ER -