The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes

Peixoto, Alberto Borges; Caldas, Taciana Mara Rodrigues da Cunha; Petrini, Caetano Galvão; Romero, Ana Cecília Palma; Júnior, Luciano Eliziário Borges; Martins, W.P.; Júnior, Edward Araujo

doi:10.14366/usg.18006

Cited by 14 publications

(19 citation statements)

References 29 publications

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“…found that chorioamnionitis was more common in women with a persistent IUH. The findings of studies assessing the association between first-trimester miscarriage and IUH are conflicting, with some showing no increased risk 1,7 and others an increased risk of miscarriage 5,6,37 . Previous studies have also suggested that the presence of IUH before 7 or 8 weeks' gestation is associated with a higher risk of miscarriage 8,38 .…”

Section: Discussionmentioning

confidence: 99%

First‐trimester intrauterine hematoma and pregnancy complications

Al‐Memar

Vaulet

Fourie

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first‐trimester miscarriage and antenatal, delivery and neonatal complications. Methods This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First‐trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi‐square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester. Results Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07–3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first‐trimester miscarriage (aOR, 0.81 (95% CI, 0.44–1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). Conclusions Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first‐trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%

First‐trimester intrauterine hematoma and pregnancy complications

Al‐Memar

Vaulet

Fourie

et al. 2020

Ultrasound in Obstet & Gyne

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“…The outcome measures of ongoing pregnancies such as gestational week at delivery, birth weight, and delivery route, were also similar both group of patients of first trimester bleeding with or without subchorionic hematoma. 15 In this study, 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries and 7.7% in pregnancies with first trimester bleeding without hematoma progressed to preterm delivery. Palatnik et al showed the occurrence of preterm birth to be more in patients with subchorionic hematoma and it was found to be 12.5%.…”

Section: Discussionmentioning

confidence: 54%

“…14 Peixoto et al in their retrospective cohort study found the incidence of intrauterine hematoma to be 4.5% (35 of 783 pregnancies) and also observed a higher proportion (28.6%) of miscarriage in pregnancy with intrauterine hematoma than those without intrauterine hematoma (10%). 15 We found that first trimester bleeding with presence of subchorionic hematoma was associated with increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart rate pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without hematoma. This higher risk of antenatal complications and preterm birth the pregnancy with first trimester bleeding along with hematoma was reflected as occurrence of nonreassuring fetal heart rate pattern, increased rate of caesarean delivery and low birth weight, however there was no significant difference in 5 minutes Apgar score and the NICU admission, in the babies of either group.…”

Section: Discussionmentioning

confidence: 75%

Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Agarwal

Ritu

Singh

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONFirst trimester bleeding complicates around 20-27% of pregnancy. 1,2 Other than routine antenatal visits, bleeding in first trimester is the most important reason for the consultation. Contributary causes are complete, incomplete or threatened abortion, implantation bleeding, ectopic pregnancy, gestational trophoblastic diseases. The end result may be termination or continuation of pregnancy depending upon cause of bleeding and other maternal factors along with factors associated with conceptus. The pregnancies after first trimester bleeding ABSTRACT Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma. Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes. Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant. Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups.

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“…However, Li et al [21] evaluated the case-control and cohort studies of the years 2000-2015 in their meta-analyses and observed that SCH caused an increased risk of spontaneous miscarriage but was not related to PL in ongoing pregnancies. Peixoto et al [22] reported increased miscarriage risk in the patients having SCH in the first trimester. Avi et al [23] reported that there was not a significant relationship between the 2D measurement of SCH, vaginal bleeding, and adverse pregnancy outcome.…”

Section: Discussionmentioning

confidence: 99%

Does the measurement of the size of the first trimester subchorionic hematoma by 2D and 3D ultrasonographic techniques have any effect on adverse pregnancy outcomes?

Özler

Guler

2019

Archives of Clinical and Experimental Medicine

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Atıf yazım şekli:How to cite:Özler S, Gümüş Güler B. Does the measurement of the size of the first trimester subchorionic hematoma by 2D and 3D ultrasonographic techniques have any effect on adverse pregnancy outcomes? Arch Clin Exp Med. 2019;4(3):118-121. AbstractAim: We aimed to evaluate whether the measurement of subchorionic hematoma (SCH) size with 2D and 3D ultrasonography affects adverse pregnancy outcomes. Methods: One hundred fifty-eight pregnant patients having SCH were enrolled in the study. The diagnosis of SCH was made by 2D and 3D ultra-sonographic methods in the first trimester, between 6th and 14th gestational weeks. Patients having SCH were determined with adverse pregnancy outcomes such as miscarriage, intrauterine fetal death (IUFD), and preterm labor (PL). Logistic regression analyses were applied for the relationship of miscarriage, IUFD, PL, and SCH.Results: There were no statistically significant differences for body mass index, 2-D hematoma sizes, 3-D hematoma sizes, and pregnancy outcomes between the groups. Miscarriage/IUFD rate was 4.6%, PL rate was 6.9%, and the term delivery rate was 88.5% in the primiparas having SCH. Miscarriage/IUFD rate was 7%, PL rate was 3.5%, and the term delivery rate was 89.5% in the multiparas having SCH. No significant association was observed between 2D and 3D hematoma sizes and IUFD and PL. In the logistic regression model, SCH ≥ 500 cm3 was found to be a risk factor associated with PL, not regarding the measurement technique (OR:1.008, 95% CI: 1.002-1.012, p=0.006). Conclusion: We determined that SCH size increases the risk of PL. We observed no effect of diagnosis and follow-up of SCH, by 2D and 3D ultrasonography techniques on adverse pregnancy outcomes such as miscarriage, IUFD, and PL. Amaç: Subkoryonik hematom (SKH) boyutunun 2B ve 3B ultrason ile ölçülmesinin olumsuz gebelik sonuçlarına etkisini değerlendirmeyi amaçladık. Yöntemler: Yüz elli sekiz SKH olan gebe çalışmaya alındı. SKH tanısı ilk trimesterde, 6. ve 14. gebelik haftaları arasında, 2 ve 3 boyutlu ultra-sonografik yöntemlerle konuldu. SKH olan gebelerin düşük, intrauterin fetal ölüm [IUFÖ] ve preterm doğum [PD] gibi olumsuz gebelik sonuçları belirlendi. SKH ile düşük, intrauterin fetal ölüm ve erken doğum arasındaki ilişkiyi belirlemek için lojistik regresyon analizleri yapıldı. Bulgular: Primipar ve multipar gebeler arasında vücut kitle indexi, 2B ultrasonografik hematom boyutları, 3B ultrasonografik hematom boyutları ve gebelik sonuçları açısından istatistiksel olarak anlamlı bir fark yoktu. SKH olan primiparlarda düşük/ IUFÖ hızı %4,6, PD hızı %6,9 ve miad doğum hızı %88,5 idi. SKH olan multiparlarda ise düşük/ IUFÖ hızı %7, PD hızı %3,5 ve miad doğum hızı %89,5 idi. 2B ve 3B hematom büyüklüğü ile IUFÖ ve PD arasında anlamlı bir ilişki gözlenmedi. Lojistik regresyon modelinde ölçüm tekniğinden bağımsız olarak SKH'un ≥500 cm3 olması erken doğumla ilişkili risk faktörü olarak bulundu (OR:1,008, %95 CI: 1,002-1,012, p=0,006). Sonuç: SKH boyutunun PD riskini artırdığını belirledik. SKH'un...

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The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes

Cited by 14 publications

References 29 publications

First‐trimester intrauterine hematoma and pregnancy complications

First‐trimester intrauterine hematoma and pregnancy complications

Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Does the measurement of the size of the first trimester subchorionic hematoma by 2D and 3D ultrasonographic techniques have any effect on adverse pregnancy outcomes?

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