Spontaneous Hemoperitoneum in Advanced Maternal Age Pregnancy

Elizabeth Stiles, Linda Zambrano Guevara, Andrew Rubenstein
In: Journal of Clinical Gynecology and Obstetrics · 2025 · vol. 14(4) , pp. 195–198 · doi:10.14740/jcgo1544 · W4417226541
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⚙ AI-generated summary by qwen3.7-flash, 2026-10-06 ⓘ

A 41-year-old woman with advanced maternal age and endometriosis risk factors experienced spontaneous hemoperitoneum from posterior uterine serosa bleeding at 36 weeks, highlighting the importance of early diagnosis.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-09-07 · read from full text ⓘ

This case report describes a 41-year-old woman at 36 weeks gestation who presented with severe abdominal pain and non-reassuring fetal heart rates, leading to an urgent cesarean delivery that revealed spontaneous hemoperitoneum. The bleeding originated from the posterior uterine serosa, indicating an extra-uterine source distinct from placental abruption or rupture, despite clear amniotic fluid. While the authors note that imaging could potentially improve earlier diagnosis, they emphasize that prompt surgical intervention was critical for ensuring maternal and fetal safety in this specific instance. This paper is centrally about endometriosis — specifically listing it as a known risk factor for spontaneous hemoperitoneum in pregnancy within the context of advanced maternal age.

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Abstract

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious condition. Risk factors include endometriosis, in vitro fertilization (IVF), prior pelvic surgeries, and advanced maternal age (AMA). We report a 41-year-old female at 36 weeks’ gestation who presented with severe abdominal pain and non-reassuring fetal heart rate. Urgent cesarean delivery (CD) revealed hemoperitoneum. Clear amniotic fluid pointed to an extra-uterine source: bleeding from the posterior uterine serosa. While prompt surgical intervention in this case ensured maternal-fetal safety, the potential value of imaging to improve earlier recognition and diagnosis is discussed. This case underscores the need to consider SHiP in pregnancies lacking other known risk factors and presenting with unexplained abdominal symptoms.
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Spontaneous Hemoperitoneum in Advanced Maternal Age Pregnancy DOI: https://doi.org/10.14740/jcgo1544Keywords: Advanced maternal age, Endometriosis, IVF, Ultrasound imagingAbstract Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious condition. Risk factors include endometriosis, in vitro fertilization (IVF), prior pelvic surgeries, and advanced maternal age (AMA). We report a 41-year-old female at 36 weeks’ gestation who presented with severe abdominal pain and non-reassuring fetal heart rate. Urgent cesarean delivery (CD) revealed hemoperitoneum. Clear amniotic fluid pointed to an extra-uterine source: bleeding from the posterior uterine serosa. While prompt surgical intervention in this case ensured maternal-fetal safety, the potential value of imaging to improve earlier recognition and diagnosis is discussed. This case underscores the need to consider SHiP in pregnancies lacking other known risk factors and presenting with unexplained abdominal symptoms. Published Issue Section License Copyright (c) 2025 The authors This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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