Endometriosis-related spontaneous hemoperitoneum in pregnancy (SHiP): report of two cases and review of the literature

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening complication, for both the mother and the fetus. Its exact incidence is unknown. Several pathophysiological mechanisms have been suggested. However, the etiology of SHiP remains unknown. Endometriosis, whose incidence is increasing, is currently recognized as a major risk factor in its development. We report the case of a patient with spontaneous rupture of the right uterine venous plexus revealed by a severe abdominal pain during delivery, and another case with spontaneous rupture of the right uterine artery revealed by hypovolemic shock and fetal distress. In both patients, exploratory laparotomy revealed hemoperitoneum and active bleeding. Hemostasis and hemodynamic stability were obtained after right adnexectomy in the first case, and uterine artery suturing in the second. These two patients with a diagnosis of SHiP had both previously been diagnosed with and treated for endometriotic lesions.