Application of a Nomogram for Predicting the Risk of Subchorionic Hematoma in Early Pregnancy With In Vitro Fertilization-Embryo Transfer/Frozen Embryo Transfer

Abstract

BackgroundSubchorionic hematoma (SCH) is common in early pregnancy achieved by in vitro fertilization-embryo transfer/frozen embryo transfer (IVF-ET/FET), and is associated with adverse obstetric outcomes. However, there are no methods known to accurately predict the occurrence of SCH.ObjectiveTo establish a nomogram prediction model for predicting the risk of SCH in early pregnancy with IVF-ET/FET and to analyze pregnancy outcomes of patients with SCH.MethodsPatients who underwent IVF-ET/FET treatment and were diagnosed with clinical pregnancy were enrolled in our study. A total of 256 patients with SCH were enrolled in the SCH group, and 526 patients without SCH in the control group. Logistic regression was used to screen risk factors for SCH, and the nomogram was developed according to the regression coefficient of relevant variables. Discrimination, effect, calibration, and the predictive model’s clinical usefulness were assessed using the C-index, the area under the receiver operating characteristic standard curve, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. The effects of SCH on pregnancy outcomes were analyzed.ResultsA multivariate logistic regression analysis showed that fresh embryo transfer, polycystic ovary syndrome, hydrosalpinx, and thin endometrium were risk factors affecting the occurrence of SCH. Based on the above factors, a predictive model for the risk of SCH was created. The model displayed good discrimination, with a C-index of 0.783 (95% confidence interval: 0.750–0.816), area under the receiver operating characteristic standard curve of 0.783, and good calibration. A high C-index value of 0.765 could still be reached in the interval validation. Decision curve analysis showed that the nomogram was clinically useful when the intervention was decided at the SCH possibility threshold of 4%–87%. For patients with successful deliveries, the occurrence of SCH did not influence the gestational weeks of delivery, mode of delivery, preterm birth, height, and weight of the newborn.ConclusionWe screened the risk factors for SCH in patients who underwent IVF-ET/FET treatment. Successful establishment of a nomogram can effectively predict the occurrence of SCH. Furthermore, the incidence of miscarriage is higher in patients with SCH.

The risk factors and impact of subchorionic hematoma in the first trimester in IVF twin pregnancies: a prospective cohort study

“…Our research also revealed that hydrosalpinx remained a risk factor for SCH even after tubal ligation or salpingectomy. This may be owing to the possibility that the immune inflammatory environment associated with hydrosalpinx can disrupt ovarian and endometrial functions, further affecting embryo quality and endometrial receptivity ( 3 ). It is well-known that PCOS is related to disordered endometrial receptivity, which presents as dysregulation of endometrial sex hormone receptors, increased endometrial insulin resistance, immune-inflammatory disorder, and altered uterine vascularity ( 11 ).…”

“…In our analysis, apart from the loss of both fetuses, SCH was not associated with other pregnancy outcomes. Similarly, Yue reported that SCH had no impact on the pregnancy outcomes of IVF pregnancies, including gestational weeks, preterm birth, and neonatal birthweight ( 3 ). Ji et al ( 8 ) and Naqvi et al ( 9 ) further reported that SCH was not associated with adverse pregnancy outcomes such as stillbirth, preeclampsia, preterm labor, low birth weight, postpartum hemorrhage, and fetal distress in twin pregnancies.…”

“…Sub-chorionic hematoma (SCH), a collection of blood between the chorionic membrane and the uterine wall, is a common ultrasonic feature in the first trimester ( 1 ). The incidence of SCH varies from 1 to 48% in singleton pregnancy ( 2 , 3 ). In recent years, SCH has become increasingly common in twin pregnancies, and many twin pregnancies were the result of in vitro fertilization (IVF) treatment ( 4 ).…”

Analysis of cancer-specific survival in patients with metastatic colorectal cancer: A evidence-based medicine study

“…Currently, the American Joint Committee on Cancer (AJCC) staging system is the primary method for predicting survival outcomes in patients with mCRC[ 9 ]. However, the T stage, N stage, and M stage are the only factors for distinguishing different prognoses, and this scheme is far from satisfactory in terms of prediction accuracy[ 10 ].…”