Multiple Episodes of Spontaneous Hemoperitoneum in Pregnancy: A Case Report on Diagnosis and Management

Introduction Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but potentially life‐threatening condition, associated with significant maternal and fetal morbidity and mortality. SHiP is characterized by sudden and nontraumatic intraperitoneal bleeding during pregnancy and up to 42 days postpartum. Case presentation A 34‐year‐old Gravida 2, Para 1, Caucasian Belgian woman presented at the emergency department of a large regional hospital at 29 weeks and 3 days with abdominal pain. After investigation, the diagnosis of SHiP was made and treated conservatively because of spontaneous resolution of complaints. Two weeks after initial presentation she was readmitted with the same complaint; however, this time she was hemodynamic unstable due to the large hematoperitoneum requiring an emergency cesarean section. Her postpartum care was complicated by a third episode day 1 postpartum due to a pseudoaneurysm. Discussion Management of SHiP is reliant on three pillars: prompt recognition and diagnosis, timely and correct intervention, and adequate follow‐up care. Awareness on SHiP risk factors and diagnosis is growing due to more comprehensive studies, systematic reviews, and more appreciation of the risks of pregnancy after endometriosis surgery or endometriosis in situ. However, diagnostic delay due to misdiagnosis remains a significant issue in SHiP cases. Management of SHiP encompasses timely advanced life support, treatment of hypovolemic shock if present, surgical treatment, and in selected cases conservative treatment could be justified. The risks and benefits of conservative and ambulatory management of SHiP should be further investigated. Conclusion Symptoms of SHiP are nonspecific. Early diagnosis is of importance since this clinical entity can be life threatening and requires intervention in most cases. In selected cases, conservative management can be an option, but further research is needed to identify which clinical and imaging variables are important for this strategy, and threshold for surgical intervention and even delivery should be low.