Table 1.

Summary of cases of spontaneous haemoperitoneum in pregnancy.

Authors	Maternal age (years)	Parity	Clinical presentations	Gestational age (weeks)	Estimated blood loss (ml)	Histology/size and number of endometriosis mass	Blood transfusion	Management	Foeto-maternal outcome
Mamah et al. 20	30 plus	Primigravida	Persistent abdominal pain misdiagnosed as acute appendicitis. MRI showed complex tubo-ovarian mass, and subsequent haemodynamic instability. Past medical hx of endometriosis	32 weeks + 5 days	4700 ml	Ovarian endometrioma	Yes. Five units of red cells	Emergency laparotomy, caesarean delivery, left salpingo-oophorectomy, and hysterectomy	Live baby. Good postop recovery
Kato et al. 21	41	GIP0	Severe abdominal pain, foetal heart rate abnormality and haemoglobin of 7.7 g/dl. Had a history of adenomyosis. Conception was via IVF	28 weeks. She had earlier presented at 12 weeks of gestation	2020 ml	Endometriotic deposits on the posterior uterine wall. Histology not done	No blood transfusion	Emergency caesarean section and haemostasis secured	Live neonate. Mother subsequently discharged on the 15th day postoperatively
Li et al. 22	32	G3P1	Severe upper and lower abdominal pain, with foetal heart rate abnormality	36 weeks + 2 days	2000 ml	None	Yes	Emergency caesarean section + transfixion of ruptured blood vessels	Live neonate. The patient was admitted to the ICU and discharged subsequently
Li et al. 22	24	G1P0	Progressive abdominal pain with palpitations, tenesmus, and dizziness. IVF-ET conception. Prior history of endometriosis	27 weeks	3600 ml	None. Stage iv endometriosis	Yes	Emergency caesarean section + double loop transfixion in the uterine anterior wall	Stillbirth. The patient made a good recovery
Huang et al. 10	35	Primigravida	Generalised lower abdominal pain with subsequent onset of maternal shock	18 weeks	1500 ml	Decidualised endometrial tissue with contiguous infiltration from the peritoneal surface to more than 5 mm deep	Not documented	Emergency laparotomy + hystorotomy and arrest of bleeding from decidualised endometriotic tissue	Stillbirth. Good postop recovery
Aliyu et al. 5	31	G1P0	Severe abdominal pain, dizziness and restlessness with a subsequent significant drop in haemoglobin from 10.8 to 3.6 g/dl	24 weeks	5000 ml	Histology of previous surgery revealed endometriosis. Endometriotic deposits were noted intraoperatively during the index surgery	Yes. Red cells × 19 units, Fresh frozen plasma × 15 units, Platelet concentrate × 8 pools and 2 units of cryoprecipitate	Laparotomy + hysterectomy	Two female neonates, fresh stillbirths. They recovered well and were discharged on the 14th day postoperatively
Yang et al. 23	23	Primigravida	Lower abdominal pain, palpitation, dizziness, nausea and abdominal bloating	29 weeks 1 day	1900 ml	None	Yes. 6 units of packed red cells	Exploratory laparotomy, caesarean section and haemostasis	Foetal death
Mayadeo et al. 24	23	Primigravida	Abdominal pain, tender uterus, abnormal foetal heart on CTG	34 weeks	1400 ml	Histology of placenta and membranes (suspicion of chorioamnionitis) revealed normal findings	Yes. 2 units of packed red cells	Exploratory laparotomy, caesarean section, and haemostasis secured involving superficial serosal veins on the posterior uterine surface	Live female neonate. Good foeto-maternal outcome and were discharged 7th day postoperatively
Brichant et al. 25	23	G2P1	Labour pains. Developed severe abdominal pain and haemodynamic instability following vaginal delivery. Previous history of surgery for right endometrioma	39 weeks	2000 ml	Right ovarian endometrioma	Not documented	Emergency exploratory laparotomy and right adnexectomy	Live female baby and good foeto-maternal outcome
Brichant et al. 25	37	GIP0	Presented for induction of labour and subsequently developed hypovolemic shock and foetal distress. Had previous surgery for endometriosis	41 weeks	2000 ml	None. Uterine artery bleeding caused by possible endometriotic adhesion	Not documented	Emergency caesarean section plus uterine artery ligation and secure of haemostasis	Good outcome. Mother discharged 5th day postoperatively

CTG: cardiotocography; g/dl: grams per decilitre, ml: millilitres; IVF: in vitro fertilisation; IVF-ET: in vitro fertilisation-embryo transfer, hx: history.