Decidual Bleeding as a Cause of Spontaneous Hemoperitoneum in Pregnancy and Risk of Preterm Birth

Marit C. I. Lier, Lier MCI, Ivo Brosens, Brosens IA, Ivo A Brosens, Velja Mijatovic, Habiba M, Marwan Habiba, Giuseppe Benagiano, Benagiano G
Gynecologic and obstetric investigation · 2017 · vol. 82(4) , pp. 313–321 · doi:10.1159/000468933 · PMID:28351025 · W2603729401
review OA: bronze CC0 ⤵ 17 in-corpus citations
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This literature review identified decidualization, particularly in endometriotic foci, as the likely cause of spontaneous hemoperitoneum in pregnancy, with subclinical decidual bleeding potentially increasing preterm birth risk.

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Abstract

BACKGROUND: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis. METHODS: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological findings at the bleeding site with histological data was found in 24 case reports (16 pregnant, 8 postpartum). RESULTS: Among pregnant women (81% primigravida), 75% had a diagnosis of endometriosis and 25% of deciduosis. Among postpartum women (38% primiparous), 63% had a diagnosis of deciduosis and 25% of endometriosis. In all cases except one, decidual cells, with or without glandular structures, were present at the bleeding site. Decidual vessels were described in 7 cases and all exhibited vascular changes, including distension of the lumen, medial disorganization, or loss of vascular integrity. These vessels were significantly different from arteries seen in the secretory endometrium, showing that structural modifications take place during the initial stage of the remodelling of placental bed spiral arteries. CONCLUSIONS: During pregnancy, a link seems to exist between ectopic decidualization, particularly that occurring in endometriotic foci, and occurrence of SHiP. In addition, subclinical decidual bleeding may be a potential risk factor for preterm labour.

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Condition tags

endometriosis

MeSH descriptors

Decidua Hemoperitoneum Pregnancy Complications Premature Birth Uterine Hemorrhage Adult Endometriosis Endometriosis Female Hemoperitoneum Humans Infant, Newborn Placenta Placenta Placenta Pregnancy Pregnancy Complications Premature Birth Risk Factors Uterine Hemorrhage

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (51)

Cited by (17)

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License: CC0 · commercial use OK