How does subchorionic hematoma in the first trimester affect pregnancy outcomes?
PubMed Central: Published on January, 2021
Subchorionic hematoma (SCH) refers
to a collection of blood between the chorionic membrane and the uterine wall as
caused by the separation of the chorion from the endometrium. It is the most
common sonographic abnormality in pregnant women with symptoms of threatened
miscarriage and the most common cause of first-trimester bleeding.
Fetal loss was considered either
early pregnancy loss (before the 22nd week) or intrauterine death (after 22nd
week), depending on the pregnancy week.
This study was designed to
investigate the association of SCH with adverse pregnancy outcomes in pregnant
women in relation to size of hematoma and control pregnant women.
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This study revealed an association of SCH regardless of
the size of hematoma with lower gestational age at delivery and higher rate of
first trimester bleeding in pregnant women, whereas increased likelihood of
< 37 gestational week delivery, first trimester vaginal bleeding, early
pregnancy loss, placental abruption, IUGR and preterm delivery was observed
with increase in size of SCH.
These findings emphasize the
importance of serial follow-up of pregnant women with SCH via sonographic
examination for the earlier detection of expected adverse pregnancy outcomes
such as IUGR and to observe the clinical course of SCH.
Conclusion:
The risk for 1st trimester vaginal bleeding, early pregnancy loss, IUGR, and placental delivery increased with increase in size of SCH, while early pregnancy loss was the parameters associated with the largest increase in risk depending on the hematoma size.
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Introduction
Subchorionic hematoma (SCH) in
pregnancy has been associated with increased risk of adverse pregnancy
outcomes. We aimed to investigate the association of SCH with adverse pregnancy
outcomes in pregnant women in relation to size of hematoma and control subjects.
Material and methods
This study included 178 pregnant
women with sono-graphically detected SCH in the 1st trimester,
and 350 pregnant controls without SCH. Data on maternal age, smoking status,
gestational week at diagnosis, location of SCH, medications before diagnosis,
gestational week at delivery, delivery route and pregnancy outcomes (first
trimester vaginal bleeding, pre-eclampsia, gestational diabetes, intrauterine
growth restriction (IUGR), placental abruption, preterm delivery < 37 weeks,
early pregnancy loss and intrauterine death) were retrieved retrospectively
from hospital records. Pregnant women with SCH were divided into 3 groups
according to the size of hematoma including small SCH (SCH-I group, n =
47), medium-size SCH (SCH-II group, n = 110) and large SCH
(SCH-III group, n = 21) groups.
Results
Subchorionic hematoma was
associated with significantly lower gestational age at delivery and higher rate
of first trimester bleeding compared with the control group, regardless of the
size of the hematoma. Placental abruption and early pregnancy loss were
significantly more common in SCH-II and -III groups than in the control group.
SCH-III group was associated with a significantly higher rate of < 37
gestational weeks at delivery (p < 0.001), first trimester
vaginal bleeding, early pregnancy loss, IUGR and preterm delivery compared to
both lesser size hematoma and control groups.
Conclusions
Our findings suggest that large SCH
might indicate an increased risk of adverse pregnancy outcomes such as 1st trimester
vaginal bleeding, early pregnancy loss, IUGR, placental abruption or preterm
delivery. These findings are important to guide the patients with SCH for
detailed clinical evaluation.
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