Nationwide survey (Japan) on spontaneous hemoperitoneum in pregnancy.

AIM: The purpose of this study was to evaluate the current state and clinical characteristics of spontaneous hemoperitoneum in pregnancy (SHiP) in Japan by performing a comprehensive survey. METHODS: We reviewed data on pregnant women who developed SHiP during 2013-2017 (for 5 years), and were admitted to any of the perinatal centers in Japan. The survey assessed maternal background and maternal and neonatal prognosis. We divided the cases into two groups, favorable and poor prognosis groups, and made comparisons between the two groups. RESULTS: Of the 407 facilities in Japan, 267 (66%) facilities responded to our survey. Overall, 31 cases of SHiP were registered. Maternal death occurred in one case (3%) due to liver bleeding with an unknown cause. Of 23 cases with a SHiP onset during pregnancy, 12 (53%) had been misdiagnosed as placental abruption. The prognosis for the fetuses included miscarriage or stillbirth in three cases (10%) and asphyxia in 12 cases (42%). There was no significant correlation between the amount of intra-abdominal blood loss and neonatal prognosis based on umbilical artery pH. Incidences of preterm birth <32 gestational weeks (adjusted odds ratio, 35.75; 95% confidence interval, 3.46-368.82) were higher in the poor prognosis group than that in the favorable group. Endometriosis and artificial reproductive techniques were both associated with 19% of all cases of SHiP. CONCLUSION: SHiP was associated with maternal death and poor fetal prognosis. Prematurity and persistent uterine contractions which might be misdiagnosed as placental abruption seem to contribute to poor fetal prognosis.

Salmonella stanley ovarian abscess with endometrioma in a pregnant woman in the third trimester.

Ovarian abscesses infected with Salmonella species are a rare clinical occurrence. A 26-year-old woman at 36 weeks gestation presented with high fever, left lower abdominal pain, and diarrhea; she was referred to our hospital 5 days after a vaginal delivery. She was diagnosed with a left ovarian abscess and underwent abscess enucleation. According to the stool findings, we speculated that the abscess was infected with Salmonella species; appropriate antibiotics were administered after the positive identification of Salmonella stanley. This case highlights the importance of treating infections in pelvic abscesses appropriately to limit the effects on fertility.