Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system.

Autor: Schreurs AMF; Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands., Overtoom EM; Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands., de Boer MA; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.; Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., van der Houwen LEE; Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands., Lier MCI; Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands., van den Akker T; Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.; Athena Institute, VU University, Amsterdam, the Netherlands., Cornette J; Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands., Vogelvang TE; Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands., Beenakkers ICM; Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands., Rosman AN; Perined, Utrecht, the Netherlands., Maas JWM; Department of Obstetrics and Gynaecology and GROW - School for Oncology and Reproduction, Maastricht UMC+, Maastricht, the Netherlands., Heineman DJ; Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Finken MJJ; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.; Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., de Vries JJJ; Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Burger NB; Department of Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Schaap TP; Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands., Bloemenkamp KWM; Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands., Mijatovic V; Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2023 Dec; Vol. 130 (13), pp. 1620-1628. Date of Electronic Publication: 2023 Jun 06.
DOI: 10.1111/1471-0528.17556
Abstrakt: 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.
(© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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