Subchorionic hematoma and pregnancy outcomes in patients with threatened miscarriage

Threatened miscarriage is the most common complication in the first half of pregnancy affecting 20-25% of women. Diagnosis of threatened miscarriage is established when there is a viable pregnancy with vaginal bleeding and a closed cervix.

Any woman who presents with threatened miscarriage; ultrasound imaging is performed to ascertain the viability, location of the placenta and the presence or absence of sub chorionic hematoma.

Subchorionic hematoma (SCH) is defined as a sonographically-detected, collection of blood between the chorion and the endometrium. Although, SCH may happen spontaneously, the exact aetiology is uncertain. They are believed to result from partial detachment of the chorionic membranes from the uterine wall. The other possible explanation could be affected trophoblast invasion and impaired change in spiral arteries at the time of implantation.

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Threatened miscarriage has been linked with increased risk of hypertensive disorders of pregnancy, preterm pre labor rupture of membranes (PPROM), spontaneous preterm labor, antepartum hemorrhage (APH), intra uterine growth retardation and Caesarean Section.

Fetal loss is also described in about one quarter of threatened miscarriage cases especially from low socioeconomic background. Some studies have mentioned SCH as a causal factor for adverse outcomes whereas other studies observed no association between SCH and affected maternal and perinatal outcomes.

This study aim to compare maternal and perinatal outcomes in patients with threatened miscarriage with or without subchorionic hematoma (SCH) at a tertiary care hospital.

Study results showed SCH in 30% of patients with threatened miscarriage and a greater proportion of women in the hematoma group to eventually have spontaneous miscarriage compared to the non-hematoma group. This finding is consistent with previous studies.

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This study has shown an increase frequency of both Small for Gestational Age (SGA) and Preeclampsia in the SCH group compared to the control group.

The women with threatened miscarriage having SCH are at a higher risk of having preeclampsia and SGA and hence these pregnancies warrant greater surveillance.

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Abstract

Objective:

To compare maternal and perinatal outcomes in patients with threatened miscarriage with or without subchorionic hematoma (SCH) at a tertiary care hospital.

Methods:

This retrospective cohort study was conducted at Aga Khan University Hospital. The study included 200 patients of <20 weeks singleton pregnancy with threatened miscarriage from January 2016 till December 2018. These patients were divided into two groups based on the presence (study group) or absence of subchorionic hematoma (control) on ultrasound imaging. Baseline demographic data and obstetric outcomes were compared for the two groups.

Results:

The incidence of subchorionic hematoma was observed to be 30.5% (61/200). Most of the patients of SCH and non SCH groups presented in first trimester. Age and BMI were similar for both groups however there were more multigravida patients in the SCH group (63%versus 46.7%). A higher number of patients in the SCH group ended up in spontaneous miscarriage in contrast to patients with no SCH (13%versus6.1) and also had a greater proportion of small for gestational age (SGA) babies (8.9%versus3.9%) though no statistical significance was observed. There were more preeclamptic patients in SCH group as compared to non SCH group (4.8%versus0.7%) and the trend was statistically significant. However, no significant correlation of hematoma size and adverse pregnancy outcomes was found in SCH group.

Conclusion:

Our study shows that women with threatened miscarriage having SCH are at a higher risk of having preeclampsia and SGA and hence these pregnancies warrant greater surveillance.

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