Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies.

Szczegóły
Abstrakt

Tytuł:: Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies.
Autorzy:: Naert MN; Icahn School of Medicine at Mount Sinai, New York, Touro College of Osteopathic Medicine, Harlem, and Maternal Fetal Medicine Associates, PLLC, New York, New York.
Khadraoui H
Muniz Rodriguez A
Naqvi M
Fox NS
Źródło:: Obstetrics and gynecology [Obstet Gynecol] 2019 Aug; Vol. 134 (2), pp. 276-281.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2004- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: New York.
MeSH Terms:: Chorion*/diagnostic imaging
Gestational Age*
Abortion, Spontaneous/*epidemiology
Hematoma/*complications
Pregnancy Complications/*diagnostic imaging
Adult ; Cohort Studies ; Female ; Hematoma/diagnostic imaging ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Retrospective Studies ; Ultrasonography, Prenatal ; Uterine Hemorrhage/epidemiology
References:: Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet 1998;63:123–8.
Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound. Obstet Gynecol 2003;102:483–7.
Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PloS One 2014;9:e111676.
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.
Pelinescu-Onciul D. Subchorionic hemorrhage treatment with dydrogesterone. Gynecol Endocrinol 2007;23(suppl 1):77–81.
Sharma G, Kalish RB, Chasen ST. Prognostic factors associated with antenatal subchorionic echolucencies. Am J Obstet Gynecol 2003;189:994–6.
Akhlaghpoor S, Tomasian A. Safety of chorionic villus sampling in the presence of asymptomatic subchorionic hematoma. Fetal Diagn Ther 2007;22:394–400.
Zhou J, Wu M, Wang B, Hou X, Wang J, Chen H, et al. The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment. J Matern Fetal Neonatal Med 2017;30:406–10.
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;37:1725–32.
Methods for estimating the due date. Committee Opinion No. 700. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e150–4.
Tong S, Kaur A, Walker SP, Bryant V, Onwude JL, Permezel M. Miscarriage risk for asymptomatic women after a normal first-trimester prenatal visit. Obstet Gynecol 2008;111:710–4.
Makrydimas G, Sebire NJ, Lolis D, Vlassis N, Nicolaides KH. Fetal loss following ultrasound diagnosis of a live fetus at 6-10 weeks of gestation. Ultrasound Obstet Gynecol 2003;22:368–72.
Børlum KG, Thomsen A, Clausen I, Eriksen G. Long-term prognosis of pregnancies in women with intrauterine hematomas. Obstet Gynecol 1989;74:231–3.
Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol 2003;102:94 –100.
Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol 1996;174:996–1002.
Ben-Haroush A, Yogev Y, Mashiach R, Meizner I. Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J 2003;5:422–4.
Asato K, Mekaru K, Heshiki C, Sugiyama H, Kinjyo T, Masamoto H, et al. Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. Eur J Obstet Gynecol Reprod Biol 2014;181:41–4.
Entry Date(s):: Date Created: 20190716 Date Completed: 20200319 Latest Revision: 20210108
Update Code:: 20240105
DOI:: 10.1097/AOG.0000000000003360
PMID:: 31306310
: Czasopismo naukowe

Objective: To assess the association of a first-trimester subchorionic hematoma with pregnancy loss in women with singleton pregnancies.
Methods: We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients had routine first-trimester ultrasound scans. We reviewed ultrasound data from the first ultrasound scan performed between 6 0/7 and 13 6/7 weeks of gestation and compared rates of pregnancy loss before 20 weeks in women with and without a subchorionic hematoma. Logistic regression analysis was used to control for potential confounding variables.
Results: From January 2015 to December 2017, a total of 2,446 women met inclusion criteria, 451 (18.4%) of whom had subchorionic hematomas. Women with subchorionic hematomas had their first ultrasound scans at an earlier gestational age (8 5/7 vs 9 6/7 weeks of gestation, P<.001) and were more likely to have vaginal bleeding (33.3% vs 8.1%, P<.001). Maternal age, race, use of in vitro fertilization, body mass index, prior number of losses, and medical comorbidities did not differ between the groups. On univariable analysis, subchorionic hematoma was associated with an increased risk of pregnancy loss before 20 weeks of gestation (7.5% vs 4.9%, P=.026); however, after adjusting for gestational age and vaginal bleeding, this association was no longer significant (adjusted odds ratio 1.13, 95% CI 0.74-1.74). In the 451 women with subchorionic hematomas, no characteristics of the subchorionic hematoma, including size by volume, largest diameter, presence of vaginal bleeding, and presence of an additional subchorionic hematoma, were associated with pregnancy loss. Post hoc power analysis showed we had 80% power to detect an increase in pregnancy loss before 20 weeks of gestation from 4.9% in women with no subchorionic hematoma to 8.3% in women with subchorionic hematoma.
Conclusion: In this cohort of women with singleton pregnancies, subchorionic hematoma before 14 weeks of gestation was not independently associated with pregnancy loss before 20 weeks of gestation.

Informacja