Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System

Anneke M.F. Schreurs; Evelien M. Overtoom; Marjon A. de Boer; Lisette E.E. van der Houwen; Marit C.I. Lier; Thomas van den Akker; Jerome Cornette; Tatjana E. Vogelvang; Ingrid C.M. Beenakkers; Ageeth N Rosman; Jacques W.M. Maas; David J. Heineman; Martijn J.J. Finken; Jan J.J. de Vries; Nicole B. Burger; Timme P. Schaap; Kitty W.M. Bloemenkamp; Velja Mijatovic

doi:10.1111/1471-0528.17556

Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System

Anneke M.F. Schreurs^*, Evelien M. Overtoom, Marjon A. de Boer, Lisette E.E. van der Houwen, Marit C.I. Lier, Thomas van den Akker, Jerome Cornette, Tatjana E. Vogelvang, Ingrid C.M. Beenakkers, Ageeth N Rosman, Jacques W.M. Maas, David J. Heineman, Martijn J.J. Finken, Jan J.J. de Vries, Nicole B. Burger, Timme P. Schaap, Kitty W.M. Bloemenkamp, Velja Mijatovic

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting: Nationwide, the Netherlands. Population: All pregnant women between April 2016 and April 2018. Methods: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

Original language	English
Pages (from-to)	1620-1628
Number of pages	9
Journal	BJOG : An International Journal of Obstetrics and Gynaecology
Volume	130
Issue number	13
Early online date	6 Jun 2023
DOIs	https://doi.org/10.1111/1471-0528.17556
Publication status	Published - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Funding

The authors thank the local coordinators of all Dutch hospitals affiliated with NethOSS. Furthermore, the authors thank Perined and the Netherlands Audit Committee Maternal Mortality and Morbidity (Auditcommissie Maternale Sterfte en Morbiditeit, AMSM) for facilitating this study and facilitating the birth registration and audit in the Netherlands.

Funders	Funder number
Netherlands Audit Committee Maternal Mortality and Morbidity

Keywords

ART
endometriosis
fetal morbidity
maternal morbidity
NethOSS
obstetric surveillance system
SHiP

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Schreurs, A. M. F., Overtoom, E. M., de Boer, M. A., van der Houwen, L. E. E., Lier, M. C. I., van den Akker, T., Cornette, J., Vogelvang, T. E., Beenakkers, I. C. M., Rosman, AN., Maas, J. W. M., Heineman, D. J., Finken, M. J. J., de Vries, J. J. J., Burger, N. B., Schaap, T. P., Bloemenkamp, K. W. M., & Mijatovic, V. (2023). Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System. BJOG : An International Journal of Obstetrics and Gynaecology, 130(13), 1620-1628. https://doi.org/10.1111/1471-0528.17556

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abstract = "Objective: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting: Nationwide, the Netherlands. Population: All pregnant women between April 2016 and April 2018. Methods: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.",

keywords = "ART, endometriosis, fetal morbidity, maternal morbidity, NethOSS, obstetric surveillance system, SHiP",

author = "Schreurs, {Anneke M.F.} and Overtoom, {Evelien M.} and {de Boer}, {Marjon A.} and {van der Houwen}, {Lisette E.E.} and Lier, {Marit C.I.} and {van den Akker}, Thomas and Jerome Cornette and Vogelvang, {Tatjana E.} and Beenakkers, {Ingrid C.M.} and Ageeth N Rosman and Maas, {Jacques W.M.} and Heineman, {David J.} and Finken, {Martijn J.J.} and {de Vries}, {Jan J.J.} and Burger, {Nicole B.} and Schaap, {Timme P.} and Bloemenkamp, {Kitty W.M.} and Velja Mijatovic",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.",

year = "2023",

month = dec,

doi = "10.1111/1471-0528.17556",

language = "English",

volume = "130",

pages = "1620--1628",

journal = "BJOG : An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "John Wiley and Sons Inc.",

number = "13",

}

Schreurs, AMF, Overtoom, EM, de Boer, MA, van der Houwen, LEE, Lier, MCI, van den Akker, T, Cornette, J, Vogelvang, TE, Beenakkers, ICM, Rosman, AN, Maas, JWM, Heineman, DJ, Finken, MJJ, de Vries, JJJ, Burger, NB, Schaap, TP, Bloemenkamp, KWM & Mijatovic, V 2023, 'Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System', BJOG : An International Journal of Obstetrics and Gynaecology, vol. 130, no. 13, pp. 1620-1628. https://doi.org/10.1111/1471-0528.17556

TY - JOUR

T1 - Spontaneous Haemoperitoneum in Pregnancy

T2 - Nationwide Surveillance and Delphi Audit System

AU - Schreurs, Anneke M.F.

AU - Overtoom, Evelien M.

AU - de Boer, Marjon A.

AU - van der Houwen, Lisette E.E.

AU - Lier, Marit C.I.

AU - van den Akker, Thomas

AU - Cornette, Jerome

AU - Vogelvang, Tatjana E.

AU - Beenakkers, Ingrid C.M.

AU - Rosman, Ageeth N

AU - Maas, Jacques W.M.

AU - Heineman, David J.

AU - Finken, Martijn J.J.

AU - de Vries, Jan J.J.

AU - Burger, Nicole B.

AU - Schaap, Timme P.

AU - Bloemenkamp, Kitty W.M.

AU - Mijatovic, Velja

PY - 2023/12

Y1 - 2023/12

N2 - Objective: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting: Nationwide, the Netherlands. Population: All pregnant women between April 2016 and April 2018. Methods: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

AB - Objective: To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. Design: A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). Setting: Nationwide, the Netherlands. Population: All pregnant women between April 2016 and April 2018. Methods: This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. Main outcome measures: Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. Results: In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. Conclusions: SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

KW - ART

KW - endometriosis

KW - fetal morbidity

KW - maternal morbidity

KW - NethOSS

KW - obstetric surveillance system

KW - SHiP

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Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System

Abstract

Bibliographical note

Funding

Keywords

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