{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T20:05:10Z","timestamp":1776369910241,"version":"3.51.2"},"update-to":[{"DOI":"10.3310\/nihropenres.13960.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000}}],"reference-count":26,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Professorship","award":["Grant Reference Number NIHR-RP-011-032"],"award-info":[{"award-number":["Grant Reference Number NIHR-RP-011-032"]}]},{"DOI":"10.13039\/501100005416","name":"Norwegian Research Council","doi-asserted-by":"crossref","award":["International mobility grant (grant no 320181)"],"award-info":[{"award-number":["International mobility grant (grant no 320181)"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Spontaneous haemoperitoneum in pregnancy (SHiP) is the occurrence during pregnancy of sudden intra-abdominal haemorrhage unrelated to extrauterine pregnancy, trauma or uterine rupture. SHiP is uncommon but is associated with preterm birth, high perinatal mortality and, more rarely, maternal mortality. We investigated the incidence of SHiP in the UK and its diagnosis, management and outcomes. Methods This two-year, prospective surveillance study used the UK Obstetric Surveillance System to collect anonymous data on all women who gave birth in a UK consultant-led maternity unit in 2016 and 2017 and who experienced SHiP. Results We confirmed 20 cases of SHiP, giving an estimated incidence of 1.3 cases per 100,000 maternities, or 1 per 75,614 maternities. The median gestational age at diagnosis was 35.7 weeks (IQR 29.9\u201338.4 weeks). A minority of affected women were receiving anticoagulant agents for prophylaxis (2\/20) or treatment (4\/20). The most common initial suspected diagnosis was placental abruption (7\/20), followed by intra-abdominal bleeding, uterine rupture, or infection. SHiP was diagnosed using ultrasound in four women, using CT in five, and solely at surgery in 14. Aneurysms (4\/20) and organ rupture or haematoma (5\/20) were the most common bleeding source, and the condition was most commonly diagnosed and treated by laparotomy (11\/20). Perinatal morbidity and mortality were high, with 16% of infants stillborn, an over 80% admission rate to the neonatal unit among the 16 live-born infants, major complications in a third of these infants, and one neonatal death. Maternal morbidity was also high, with 60% of women admitted to the intensive care unit, over half of whom experienced major morbidity, and one maternal death. Conclusions SHiP is rare in the UK but when it occurs, it can be associated with major maternal morbidity and mortality, and perinatal outcomes are poor. International comparisons are complicated by differing definitions of SHiP.<\/ns3:p>","DOI":"10.3310\/nihropenres.13960.2","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T12:20:10Z","timestamp":1749212410000},"page":"40","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Incidence, outcomes and management of spontaneous haemoperitoneum in pregnancy: a UK population-based study"],"prefix":"10.3310","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-1808","authenticated-orcid":false,"given":"Ruth","family":"Tunn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6784-8319","authenticated-orcid":false,"given":"Rema","family":"Ramakrishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1582-4283","authenticated-orcid":false,"given":"Hilde Marie","family":"Engjom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-4575","authenticated-orcid":false,"given":"Marian","family":"Knight","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"57-65","DOI":"10.1016\/j.ejogrb.2017.10.012","article-title":"Spontaneous Hemoperitoneum in Pregnancy (SHiP) and endometriosis \u2014 a systematic review of the recent literature.","volume":"219","author":"M Lier","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1220-1226","DOI":"10.1111\/aogs.14431","article-title":"Spontaneous Hemoperitoneum in Pregnancy: Italian prospective population-based cohort study.","volume":"101","author":"M Mazzocco","year":"2022","journal-title":"Acta Obstet Gynecol Scand."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"1620-8","DOI":"10.1111\/1471-0528.17556","article-title":"Spontaneous hemoperitoneum in pregnancy: nationwide surveillance and Delphi audit system.","volume":"130","author":"A Schreurs","year":"2023","journal-title":"BJOG."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"1243-1245","DOI":"10.1016\/j.fertnstert.2009.03.091","article-title":"Endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy.","volume":"92","author":"I Brosens","year":"2009","journal-title":"Fertil Steril."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"744-52","DOI":"10.1111\/jog.15498","article-title":"Endometriosis-related spontaneous hemoperitoneum in pregnancy: a case series.","volume":"49","author":"L Bazzurini","year":"2023","journal-title":"J Obstet Gynaecol Res."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"692-703","DOI":"10.1016\/j.fertnstert.2016.05.025","article-title":"Severe spontaneous hemoperitoneum in pregnancy may be linked to in vitro fertilization in patients with endometriosis: a systematic review.","volume":"106","author":"I Brosens","year":"2016","journal-title":"Fertil Steril."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"2646-2652","DOI":"10.1111\/jog.14819","article-title":"Nationwide survey (Japan) on spontaneous hemoperitoneum in pregnancy.","volume":"47","author":"M Hagimoto","year":"2021","journal-title":"J Obstet Gynaecol Res."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"47-59","DOI":"10.1016\/j.beem.2018.10.001","article-title":"Assisted reproduction in endometriosis.","volume":"33","author":"D de Ziegler","year":"2019","journal-title":"Best Pract Res Clin Endocrinol Metab."},{"key":"ref-9","article-title":"Saving lives, improving mothers\u2019 care core report - 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Mamah, University of Nigeria, Nsukka, Enugu, 25 Jun 2025, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/5-40\/v2#referee-response-35956","order":0,"name":"referee-response-35956","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.15176.r35752, Julia Sanders, Cardiff University, Cardiff, 03 Jun 2025, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/5-40\/v1#referee-response-35752","order":1,"name":"referee-response-35752","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by the National Institute for Health and Care Research (NIHR) under an NIHR Professorship to Marian Knight, Grant Reference Number NIHR-RP-011-032. The views expressed are those of the author(s) and not necessarily those of the NIHR, the University of Oxford or the Department of Health and Social Care. Hilde Marie Engjom participated in this work as part of an international mobility grant from the Norwegian Research Council (grant no 320181). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}