{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:32:06Z","timestamp":1782603126082,"version":"3.54.5"},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Spontaneous hemoperitoneum in pregnancy is defined as a sudden non\u2010traumatic intraperitoneal bleeding in pregnancy and up to 42\u2009days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This is a prospective population\u2010based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42\u2009days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR\u00a0=\u00a06.60, 95% CI 2.52\u201317.29), in the case of multiple pregnancies (RR\u00a0=\u00a06.57, 95% CI 1.99\u201321.69) and maternal age\u2009\u226535\u2009years (RR 2.10, 95% CI 1.01\u20134.35). In 17\/29 cases the bleeding site was intra\u2010pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900\u2009mL, one hysterectomy was necessary, and two women died. Twenty\u2010two preterm births were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Spontaneous hemoperitoneum in pregnancy is a rare, life\u2010threatening condition associated with high perinatal morbidity and mortality. Maternal age\u2009\u226535\u2009years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14431","type":"journal-article","created":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T09:40:31Z","timestamp":1662025231000},"page":"1220-1226","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Spontaneous hemoperitoneum in pregnancy: Italian prospective population\u2010based cohort study"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-6248","authenticated-orcid":false,"given":"Martina Ilaria","family":"Mazzocco","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Hospital Vittore Buzzi Department of Biomedical and Clinical Sciences, University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4607-2072","authenticated-orcid":false,"given":"Serena","family":"Donati","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0 \u2010 Italian National Institute of Health  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-5385","authenticated-orcid":false,"given":"Alice","family":"Maraschini","sequence":"additional","affiliation":[{"name":"Technical\u2010scientific statistical service Italian National Institute of Health  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Corsi","sequence":"additional","affiliation":[{"name":"National Center for Disease Prevention and Health Promotion Istituto Superiore di Sanit\u00e0 \u2010 Italian National Institute of Health  Rome Italy"},{"name":"Department of Biomedicine and Prevention University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Colciago","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery University of Milano\u2010Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Guelfi","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Hospital Vittore Buzzi Department of Biomedical and Clinical Sciences, University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9217-3034","authenticated-orcid":false,"given":"Irene","family":"Cetin","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Hospital Vittore Buzzi Department of Biomedical and Clinical Sciences, University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.10.012"},{"key":"e_1_2_11_3_1","volume-title":"Saving Lives, Improving Mothers' Care \u2010 Lessons Learned to Inform Future Maternity Care from the UKand Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009\u201312","author":"Knight M","year":"2014"},{"issue":"4","key":"e_1_2_11_4_1","first-page":"363","article-title":"The way to move beyond the numbers: the lesson learnt from the Italian obstetric surveillance system","volume":"55","author":"Donati S","year":"2019","journal-title":"Ann Ist Super Sanit\u00e0"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2016.05.025"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14819"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2009.01.007"},{"key":"e_1_2_11_8_1","unstructured":"Near miss ostetrici in Italia; la sepsi l'eclampsia l'embolia di liquid amniotico e le'emoperitoneo spontaneo in gravidanza [Near miss cases in obstetrics in Italy: sepsis eclampsia amniotic fluid embolism and spontaneous hemoperitoneum]. In Italian. February 2021.https:\/\/www.ccm\u2010network.it\/imgs\/C_27_MAIN_progetto_544_listaFile_List11_itemName_0_file.pdf"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14833"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2009.03.091"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14371"},{"key":"e_1_2_11_12_1","unstructured":"BoldriniR Di CesareM BasiliF et al.Certificato di Assistenza al Parto (CeDAP) Analisi dell'evento nascita \u2010 Anno 2018. [Childbirth Assistance Certificate (CeDAP) Analysis of the birth event \u2010 Year 2018.]. In Italian. Direzione Generale della Digitalizzazione del Sistema Informativo Sanitario e della Statistica \u2013 Ufficio di statistica. 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