Spontaneous hemoperitoneum in pregnancy: a rare case report

Anuradha Singh, Kiran Aggarwal, Nikita Krishna, S. M. Sinha, Prabha Lal
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(7) , pp. 2388–2390 · doi:10.18203/2320-1770.ijrcog20251997 · W4411679881
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This case report describes a 40-year-old woman at 30 weeks gestation who underwent emergency laparotomy and hysterectomy for spontaneous hemoperitoneum, resulting in the successful recovery of both mother and infant.

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This case report describes a 40-year-old multigravida at 30 weeks gestation who presented with acute abdominal pain and was diagnosed with spontaneous hemoperitoneum via urgent imaging. Emergency laparotomy revealed significant intra-abdominal bleeding, leading to a caesarean section followed by a total abdominal hysterectomy due to suspected uterine rupture and severe postpartum hemorrhage. The authors emphasize that early recognition and prompt surgical intervention are critical for preventing maternal and fetal mortality in such rare and diagnostic challenges. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening condition with an estimated incidence rate of 0.04 per 1000 births. It is characterized by the accumulation of blood in the peritoneal cavity without trauma or obvious cause in pregnancy and up to 42 days postpartum that lead to significant maternal and perinatal complications. SHiP mostly occurs in third trimester of pregnancy with an incidence of 27% in the second trimester. A 40-year-old multigravida female at 30 weeks of gestation who presented with acute abdominal pain. Urgent imaging revealed a small amount of free fluid in perihepatic and perisplenic space with blood clots highly suggestive of hemoperitoneum. An emergency laparotomy was performed which confirmed the diagnosis and approximately 1-1.5 litres of hemoperitoneum with 1 litre of blood clot from pouch of douglas were evacuated. Caesarean section was performed at the same time placenta was delivered with intact membranes. There was atonic post-partum haemorrhage (PPH) which was not medically managed, so in view of doubt of rent in lower uterine segment with increased vascularity over the post surface, atonic PPH and general condition of the patient, total abdominal hysterectomy was done. Total blood loss was 3.5 litres. Both mother and baby recovered without further complications. This case highlights the importance of early recognition and prompt surgical intervention in SHiP to prevent maternal and fetal morbidity and mortality. Given its rarity and non-specific presentation, SHiP remains a diagnostic challenge and requires a high index of suspicion in pregnant women with acute abdomen and hemodynamic instability.
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Spontaneous hemoperitoneum in pregnancy: a rare case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20251997Keywords: Pregnancy, Spontaneous hemoperitoneum, Third trimester, Acute abdomenAbstract Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening condition with an estimated incidence rate of 0.04 per 1000 births. It is characterized by the accumulation of blood in the peritoneal cavity without trauma or obvious cause in pregnancy and up to 42 days postpartum that lead to significant maternal and perinatal complications. SHiP mostly occurs in third trimester of pregnancy with an incidence of 27% in the second trimester. A 40-year-old multigravida female at 30 weeks of gestation who presented with acute abdominal pain. Urgent imaging revealed a small amount of free fluid in perihepatic and perisplenic space with blood clots highly suggestive of hemoperitoneum. An emergency laparotomy was performed which confirmed the diagnosis and approximately 1-1.5 litres of hemoperitoneum with 1 litre of blood clot from pouch of douglas were evacuated. Caesarean section was performed at the same time placenta was delivered with intact membranes. There was atonic post-partum haemorrhage (PPH) which was not medically managed, so in view of doubt of rent in lower uterine segment with increased vascularity over the post surface, atonic PPH and general condition of the patient, total abdominal hysterectomy was done. Total blood loss was 3.5 litres. Both mother and baby recovered without further complications. This case highlights the importance of early recognition and prompt surgical intervention in SHiP to prevent maternal and fetal morbidity and mortality. Given its rarity and non-specific presentation, SHiP remains a diagnostic challenge and requires a high index of suspicion in pregnant women with acute abdomen and hemodynamic instability. Metrics References Nayak D, Thangavel A, Sagili H. Spontaneous Hemoperitoneum in Third Trimester of Pregnancy-an Enigma. J Obstet Gynaecol India. 2022;72(5):449-53. DOI: https://doi.org/10.1007/s13224-021-01522-w Huang LY, Hsu PY, Chiang CT, Chen HW, Wu MH. Endometriosis-related spontaneous hemoperitoneum in the early second trimester: A case report. Taiwan J Obstet Gynecol. 2021;60(2):328-30. DOI: https://doi.org/10.1016/j.tjog.2021.01.032 Mamah J, Thomas M, Rafi J. Spontaneous Hemoperitoneum in Pregnancy: Masquerading as Acute Appendicitis. Cureus. 2023;15(10):e47040. DOI: https://doi.org/10.7759/cureus.47040 Lier M, Malik RF, van Waesberghe J, Maas JW, van Rmpt-van de Geest DA, et al. Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series. BJOG. 2017;124:306-12. DOI: https://doi.org/10.1111/1471-0528.14371 Mazzocco MI, Donati S, Maraschini A, Corsi E, Colciago E, Guelfi F, et al. Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study. Acta Obstet Gynecol Scand. 2022;101(11):1220-6. DOI: https://doi.org/10.1111/aogs.14431

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