Outcomes of subchorionic hematoma-affected pregnancies in the infertile population
International Journal of Gynecology & Obstetrics: Published
on February 2022
A subchorionic hematoma (SCH) is a
common finding on obstetric ultrasounds, and the prevalence is often higher
among the infertile population—affecting between 18%–40% of those pregnancies
in recent studies. SCHs are collections of fluid seen on ultrasound
between the chorion and the uterine wall, representing a collection of blood.
TAKE HOME MESSAGE:
The impact of SCH on early
pregnancies has been disputed; prior studies in the fertile population have
shown increased rates of pregnancy loss, while recent studies demonstrate
no increased risk.
Given the high reported incidence
of SCH among the infertile population, understanding the influence of SCH in
these pregnancies is of paramount importance for clinical management, including
counseling patients on expectations surrounding pregnancy outcomes.
Thus, the objectives of this study
were (1) to determine risk factors for development of SCH in the infertile
population, (2) to determine whether SCH was associated with first trimester
pregnancy loss, and (3) to evaluate pregnancy outcomes of SCH-affected
pregnancies.
In this retrospective study review
of over 1200 pregnancies at a single fertility clinic, authors found that the
presence of SCH did not vary by fertility treatment cycle or infertility
diagnosis, aside from male factor infertility.
Importantly, authors found that
incidental SCH in the infertile population was not associated with an increased
risk of miscarriage or adverse pregnancy outcomes.
CONCLUSIONS:
In conclusion, risk factors for SCH
in the infertile population include male factor infertility and aspirin use,
but not fertility treatment type or embryo grade.
There is no increased risk of
miscarriage among pregnancies impacted by SCH. However, patients presenting
with SCH and both vaginal bleeding and cramping were at an increased risk of
miscarriage compared to patients with no symptoms or only vaginal bleeding.
There are no differences in pregnancy outcomes for patients with SCH. These findings should reassure patients and providers with asymptomatic SCH and improve counseling for patients with symptomatic SCH.
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Objective
To determine the implications of an
incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile
population.
Methods
Retrospective cohort study at a
tertiary care, university-based facility. All patients with intrauterine
pregnancy on initial obstetric ultrasound presenting to an infertility clinic
between January 2015 and March 2018 (n = 1210), regardless of
treatment cycle, were included. Nonviable pregnancies were excluded. The main
outcome measured was association between subchorionic hematoma and first
trimester miscarriage.
Results
The prevalence of subchorionic
hematoma was 12.5% (n = 151) and did not differ by type of
fertility treatment. There was no association between subchorionic hematoma and
first trimester miscarriage; however, among patients with subchorionic
hematoma, those who reported both bleeding and cramping had an increased
probability of miscarriage compared to those without symptoms (0.62 vs. 0.12).
The live birth rate in this sample was 81.3% and there were no statistically
significant differences in pregnancy outcomes between those with and without
subchorionic hematoma.
Conclusion
Among an infertile population,
there was no increased risk of miscarriage when subchorionic hematoma was seen
on early ultrasound; however, when patients noted both vaginal bleeding and
cramping, their probability of miscarriage was significantly increased.
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