Spontaneous Hemoperitoneum in Advanced Maternal Age Pregnancy

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.