Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies

Naert, Mackenzie N.; Khadraoui, Hanaa; Rodríguez, A.; Naqvi, Mariam; Fox, Nathan S.

doi:10.1097/aog.0000000000003360

Cited by 34 publications

(37 citation statements)

References 13 publications

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“…Studies investigating the relationship of SCH and clinical outcome have largely been performed in singletons, and have been limited by their lack of complete and potentially meaningful clinical information such as vaginal bleeding. [1][2][3][4] Our findings are consistent with our findings in singleton pregnancies 6,7 and in contrast to what was previously reported in singleton pregnancies, in which several studies showed an increased risk of adverse pregnancy outcomes, primarily preterm birth. [1][2][3][4] One study that sought to understand the implications of SCH among twin pregnancies focused on vaginal bleeding and miscarriage, and not late pregnancy outcome.…”

Section: Commentsupporting

confidence: 92%

“…that after controlling for differences in baseline characteristics such as gestational age and bleeding, first trimester SCH was no longer significantly associated with pregnancy loss nor third trimester adverse pregnancy outcomes. 6,7 Among women with twin pregnancies, a group of women with an increased baseline risk for preterm birth and growth restriction, the relationship between SCH and adverse pregnancy outcome is even less clear. Though SCH has been associated with vaginal bleeding in a subset of women with twin pregnancies who underwent in vitro fertilization (IVF), the independent association between SCH and pregnancy outcomes in twin pregnancies is not well understood-particularly as IVF may be independent predictor of SCH.…”

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confidence: 99%

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Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

et al. 2019

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Objective This study estimates the association of a first trimester finding of subchorionic hematoma (SCH) with third trimester adverse pregnancy outcomes in women with twin pregnancies. Study Design Retrospective cohort study of twin pregnancies prior to 14 weeks at a single institution from 2005 to 2019, all of whom had a first trimester ultrasound. We excluded monoamniotic twins, fetal anomalies, history of fetal reduction or spontaneous reduction, and twin-to-twin transfusion syndrome. Ultrasound data were reviewed, and we compared pregnancy outcomes after 24 weeks in women with and without a SCH at their initial ultrasound 60/7 to 136/7 weeks. Regression analysis was used to control for any differences in baseline characteristics. Results A total of 760 women with twin pregnancies met inclusion criteria for the study, 68 (8.9%) of whom had a SCH. Women with SCH were more likely to have vaginal bleeding and had their initial ultrasound at earlier gestational ages. On univariate analysis, SCH was not significantly associated with gestational age at delivery, preterm birth, birthweight of either twin, low birthweight percentiles of either twin, fetal demise, or preeclampsia. SCH was associated with placental abruption on univariate analysis, but not after controlling for vaginal bleeding and gestational age at the time of the initial ultrasound (adjusted odds ratio: 2.00, 95% confidence interval: 0.63–6.42). Among women with SCH, SCH size was not associated with adverse pregnancy outcomes. Conclusion In women with twin pregnancies, the finding of a first trimester SCH is not associated with adverse pregnancy outcomes >24 weeks.

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confidence: 92%

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Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

et al. 2019

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“…Tuuli et al reported an increased risk of pregnancy loss in women with subchorionic hematoma (17.6% vs 8.9%) in a meta-analysis in 2011 [13]. Recently, Naert reported that first-trimester subchorionic hematoma before 14 weeks of gestation was not independently associated with pregnancy loss before 20 weeks of gestation [14]. It was not associated with adverse pregnancy outcomes in women at more than 20 weeks of gestation [15].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Howard T et al compared four methods of measurement and found that subjective hematoma size based on the fraction of the gestational sac size correlated best with first-trimester pregnancy outcome [19]. Since the subjective evaluation method was difficult in twin pregnancies, three orthogonal hematoma measurements were performed, and the conclusion was the same as that of Mackenzie N et al [14].…”

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confidence: 99%

Association Between First-Trimester Intrauterine Hematoma and Twin Pregnancy Outcomes: A Retrospective Cohort Study

Jiao

et al. 2020

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Background: In recent years, we have found that first-trimester intrauterine hematoma in twin pregnancy has become increasingly common. The majority of studies on intrauterine hematoma have excluded twin pregnancies, while others did not differentiate between singleton and twin pregnancies. The associations in twin pregnancy are not clear. Therefore, the primary objective of our study was to examine the associations between first-trimester intrauterine hematoma and pregnancy outcomes in twin pregnancy. Material and methods: 1020 twin pregnancies in women who underwent a routine examination from January 2014 to December 2018 were enrolled. According to the presence or absence of intrauterine hematoma, we compared the baseline data and pregnancy outcomes between two groups. Multivariable logistic regression analysis was used to adjust for possible confounding factors. Results: A total of 209 patients (21.3%) developed intrauterine hematoma in the first trimester. First-trimester intrauterine hematoma was significantly associated with increased odds of miscarriage (adjusted odds ratio 14.27, 95% CI 8.25-24.70) and the vanishing twin syndrome (adjusted odds ratio 3.26, 95% CI 1.11-4.61). However, It did not have increased odds of adverse pregnancy outcomes after 20 Weeks of Gestation .In the final regression model analysis, the associations of hematoma with previous miscarriage history, accepted assisted conception, accompanying vaginal bleeding and miscarriage and vanishing twin syndrome were no longer significant. No association was found between hematoma size or the presence of vaginal bleeding and the risk of pregnancy loss or the vanishing twin syndrome before 20 weeks of gestation (P>0.05). Conclusion: In women with twin pregnancies, the presence of intrauterine hematoma in the first trimester was associated with one or both fetal losses before 20 weeks of gestation. However, chorionicity in twins, the conception method, the intrauterine hematoma size and the presence of vaginal bleeding were not independently associated with pregnancy loss.

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“…Reported adverse outcomes associated with SCH in non-IVF pregnancies include increased risk of pregnancy loss, abruption, preterm premature rupture of membranes (PPROM), and fetal growth restriction [4][5][6][7][8]. Recent publications have suggested that SCH before 14 weeks of gestation is neither associated with pregnancy loss before 20 weeks of gestation nor adverse pregnancy outcomes after 20 weeks of gestation [9,10]. Moreover, a recent retrospective cohort study of 1097 IVF cases suggested that, although SCH was associated with lower birth weight in singleton gestations, the pregnancy loss rate was not increased among IVF/ICSI patients.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with subchorionic hematoma formation in pregnancies achieved via assisted reproductive technologies

West

Kavoussi

Odenwald

et al. 2020

J Assist Reprod Genet

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Purpose To determine if certain clinical and/or embryologic factors are independently associated with the increased prevalence of subchorionic hematoma (SCH) among pregnancies achieved via in vitro fertilization (IVF) with fresh embryo transfer (ET). Design Retrospective chart review. Methods In this retrospective study, data were abstracted from 210 autologous oocyte IVF clinical pregnancies that resulted from fresh ET at a single fertility center from January 2012 through December 2016. Clinical and embryology laboratory variables were analyzed as possible factors associated with the presence or absence of SCH in IVF pregnancies via bivariate associations and multivariable logistic regression analyses. Independent variables included prior uterine surgery versus no uterine surgery, peak estradiol, and progesterone levels, day 3 (n = 92) versus day 5 (n = 118) ET, and assisted hatching versus no assisted hatching. Among the day 5 ET subgroup of 118 patients, 117 had data for the variables inner cell mass (ICM) grading and trophectoderm (TE) because one day 5 ET was at the morula stage. Results We found a significant bivariate association between TE grading and SCH, where cases with TE grade "A" were significantly less likely to have SCH compared with cases with grades "B" or "C." This significant difference remained when adjusting for the other factors considered in a multivariable logistic regression model for the probability of SCH. Conclusions The data analyzed here suggest that a less-advanced trophectoderm grade may be a potential factor that is associated with the presence of SCH in pregnancies achieved via IVF.

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Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies

Cited by 34 publications

References 13 publications

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies

Association Between First-Trimester Intrauterine Hematoma and Twin Pregnancy Outcomes: A Retrospective Cohort Study

Factors associated with subchorionic hematoma formation in pregnancies achieved via assisted reproductive technologies

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