DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195640

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

Kiran Agarwal, Ritu ., Amrita Singh, Anjali Singh, Amrita Mishra

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.


Keywords


Feto-maternal outcome, First trimester bleeding, Miscarriage, Preeclampsia, Subchorionic haematoma

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References


Farrell T, Owen, P. The significance of extra- chorionic membrane separation in threatened miscarriage. Br J Obstet Gynaecol. 1996;103:926-8.

Hasan R, Baird DD, Herring AH, Olshan AF, Funk ML, Hartmann KE. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Ann Epidemiol. 2010;20(7):524-31.

Heller HT, Asch EA, Durfee SM, Goldenson RP, Peters HE, Ginsburg ES, et al. Subchorionic hematoma: correlation of grading techniques with first‐trimester pregnancy outcome. J Ultrasound Med. 2018;37(7):1725-32.

Nagy S, Bush M, Stone J, Lapinski R, Gardó S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Orv Hetil. 2005;146(42):2157-61.

Pearlstone M, Baxi L. Subchorionic hematoma: a review. Obstet Gynecol Surv. 1993;48:65-8.

Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996;174:996-1002.

Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet. 1998;63:123-8.

Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105:339-44.

Jauniaux E, Van Oppenraaij RH, Burton GJ. Obstetric outcome after early placental complications. Curr Opin Obstet Gynecol. 2010;22:452-7.

Falco P, Milano V, Pilu G, David C, Grisolia G, Rizzo N, et al. Sonography of pregnancies with first-trimester bleeding and a viable embryo: a study of prognostic indicators by logistic regression analysis. Ultrasound Obstet Gynecol. 1996;7:165-9.

Tower CL, Regan L. Intrauterine haematomas in a recurrent miscarriage population. Hum Reprod. 2001;16:2005-7.

Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound Obstet Gynecol. 2005;25(6):613-24.

Bushtyreva IO, Kuznetsova NB, Barinova VV, Kovaleva AV, Dmitrieva MP. Pregnancy outcomes in pregnant women with subchorionic hematoma. Int J Biomed. 2015;5(3):137-40.

Emre Y. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. J Turk Ger Gynecol Assoc. 2014;15:239-42.

Peixoto AB, da Cunha Caldas TMR, Petrini CG, Romero ACP, Borges Júnior LE, Martins WP, et al. The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes. Ultrasonography. 2018;37(4):330-6.

Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117:1205-12.

Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010;117:245-57.

Palatnik A, Grobman WA. The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. Am J Obstet Gynecol. 2015;213:403.e1-4.