{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:23:32Z","timestamp":1788953012684,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based cohort study using the Netherlands Obstetric Surveillance System (NethOSS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Nationwide, the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All pregnant women between April 2016 and April 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100\u2009000 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\u2010abdominal 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17556","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T02:52:26Z","timestamp":1686192746000},"page":"1620-1628","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-0632","authenticated-orcid":false,"given":"Anneke M. F.","family":"Schreurs","sequence":"first","affiliation":[{"name":"Department of Reproductive Medicine Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6454-4531","authenticated-orcid":false,"given":"Evelien M.","family":"Overtoom","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjon A.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"},{"name":"Department of Obstetrics and Gynaecology Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette E. 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I.","family":"Lier","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Centre  Leiden the Netherlands"},{"name":"Athena Institute, VU University  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome","family":"Cornette","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine Erasmus MC  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana E.","family":"Vogelvang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Diakonessenhuis  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid C. M.","family":"Beenakkers","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3751-2950","authenticated-orcid":false,"given":"Ageeth\u00a0N.","family":"Rosman","sequence":"additional","affiliation":[{"name":"Perined  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques W. M.","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology and GROW \u2013 School for Oncology and Reproduction Maastricht UMC+  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Heineman","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cardiothoracic Surgery Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn J. J.","family":"Finken","sequence":"additional","affiliation":[{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam the Netherlands"},{"name":"Department of Paediatric Endocrinology, Emma Children's Hospital Amsterdam UMC, Vrije Universiteit Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan J. 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