Subchorionic Hematoma
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Subchorionic Hematoma
Subchorionic hematoma (SCH) during pregnancy is associated with an increased risk of adverse pregnancy outcomes. We aimed to investigate the association of SCH with adverse pregnancy outcomes in pregnant women with hematoma size and control issues.
Pregnancy Ultrasound For Srh Work (chapter 7)
This study included 178 pregnancies with SCH detected by ultrasound in the 1st trimester and 350 controls without SCH. Maternal age, smoking status, gestational week at diagnosis, location of SCH, medications prior to diagnosis, gestational week at delivery, route of delivery, and pregnancy outcomes (first trimester vaginal bleeding, preeclampsia, gestational diabetes, intrauterine growth restriction (IUGR)), placental abruption, premature birth
Our results suggest that large SCH may increase the risk of adverse pregnancy outcomes such as 1st trimester vaginal bleeding, early pregnancy loss, IUGR, placental abruption, or preterm birth. These findings are important for accurate clinical evaluation of patients with SCH.
Subchorionic hematoma (SCH) refers to the collection of blood between the chorionic membrane and the uterine wall due to separation of the chorion from the endometrium [1, 2]. It is the most common sonographic abnormality in pregnant women with signs of threatened abortion and the most common cause of first trimester bleeding [3, 4]. In the general obstetric population, the incidence of SCH may increase from 1.7% to 3.1%, and in pregnant women with signs of threatened abortion, it may increase to 20% [ 3 , 5 ].
Although SCH is a common abnormality associated with adverse pregnancy outcomes, such as early pregnancy loss, placental abruption, and preterm birth, the exact impact of SCH on pregnancy outcomes is unclear, due to the ongoing debate about the risk of miscarriage in early pregnancies complicated by SCH. as well as the clinical significance of SCH size in terms of adverse pregnancy outcomes [4, 6-13].
Subchorionic Hematoma: Symptoms, Causes, Risks, Treatment
Therefore, this study was designed to investigate the association with adverse pregnancy outcomes in pregnant women and control pregnant women.
A total of 178 women with a singleton pregnancy detected by ultrasonography in the first trimester (<14 weeks) from January 2014 to January 2018, in a tertiary care hospital, were included in this study. A total of 350 pregnant women without SCH made up the control group. The presence of fetal heart activity at the time of diagnosis of SCH was a prerequisite for inclusion in the study, while the presence of a non-viable fetus, multiple pregnancy, fetal abnormalities on ultrasound and pre-gestational diabetes and/or hypertension were exclusion criteria.
Written informed consent was obtained from each participant. The study was approved by the Local Ethics Committee of Goztepe Education and Research Hospital, Medeniyet University, Istanbul, Turkey.
Maternal age, smoking status, gestational week at diagnosis, location of SCH, medications prior to diagnosis, gestational week at delivery, route of delivery, and pregnancy outcomes (first trimester vaginal bleeding, preeclampsia, gestational diabetes, intrauterine growth restriction (IUGR)), placental abruption, preterm birth < 37 weeks, early pregnancy loss and intrauterine death) were retrieved from retrospective hospital records.
Our First Pregnancy Experience With A Subchorionic Haematoma Wedded Wanderers
Subchorionic hematoma was diagnosed by the same obstetrician and gynecologist in all women by transvaginal ultrasound examination (SonoScape S11, 2013) in the first trimester. Pregnant women with SCH were divided into 3 groups based on hematoma size (the ratio of the largest linear diameter of the SCH to the linear diameter of the gestational sac), including small SCH (SCH-I group, ratio 1/2, n = 21) (Figure 1). )
Ultrasound image: ‘a’ depicting the longest dimension of the subchorionic hematoma and ‘b’ depicting the longest diameter of the gestational sac. Subchorionic hematomas were grouped according to a/b ratios
Week), depending on the week of pregnancy. Preeclampsia was defined as new-onset hypertension (blood pressure > 140/90 mm Hg on two consecutive measurements 4 hours apart after 20 hours).
Week of pregnancy) and accompanying proteinuria (300 mg/day or +2 dipstick proteinuria or urine protein/creatinine ≥ 0.3 mg protein/mg creatinine) [14]. Gestational diabetes is diabetes diagnosed in the second half of pregnancy based on a 50g oral glucose tolerance test at 24-28 years of age.
Prognosis Of Very Large First‐trimester Hematomas
With interest The obstetrician-gynecologist detected placental abruption during delivery and placental examination. Delivery before the 37th
The data obtained in the study were statistically analyzed using SPSS 25.0 software (IBM Corporation, Armonk, NY, USA). The agreement of the data with the normal distribution was evaluated by the Shapiro-Wilk test, and the homogeneity of the variances by the Levene’s test. Multiple independent groups of quantitative data meeting parametric conditions for age (control group and SCH group) were compared using one-way ANOVA. The Kruskal-Wallis H test with the results of the Monte Carlo simulation technique was used as a non-parametric test when comparing diagnosis at the time of delivery and gestational week, and Dunn’s test for post hoc analyses. Control and SCH groups (I, II and III) according to parity, gestational week at delivery, vaginal bleeding in the first trimester, smoking, mode of delivery, early pregnancy loss, IUGR, placental abruption, preterm delivery, preeclampsia, control- and SCH- when comparing groups. gestational diabetes and intrauterine death, linear-by-linear association, and Fisher-Freeman-Holton tests were performed using Monte Carlo simulation, and column ranks were compared to each other and expressed as Benjamini-Hochberg-adjusted p-values. the results Multiple logistic regression analysis was used to determine causal relationships between explanatory variables (such as gestational week at diagnosis, gestational week at delivery, first trimester vaginal bleeding, early pregnancy loss, IUGR, placental abruption, preterm delivery) and response variables. (control and SCH groups). In the tables, quantitative variables are shown as mean ± standard deviation (SD) and median (minimum/maximum), and categorical variables are shown as number (n) and percentage (%). Variables were evaluated at the 95% confidence level, and a value of p < 0.05 was considered statistically significant.
Although not statistically significant, a trend toward earlier gestational age at diagnosis was noted in larger hematomas (mean 8.0 weeks in the SCH-III group, 8.3 weeks in the SCH-II group, and 8.0 weeks in the SCH-I group (9 weeks). Compared with subchorionic hematoma, compared to SCH I, II and III groups, the gestational age at delivery is significantly lower (median (min-max) 38.29 (8.43-40.71), 37.93 (7.86-40 , 43) and 27.86 (7.86-37.57) and 38.86 (7.14-42.00) weeks in the control group, p < 0.001) and a higher bleeding rate in the first trimester (SCH I, II and % 21.3, 36.4% and 76.2% in III groups, respectively, 6.0). % in the control group, p < 0.001) compared to the control group, regardless of hematoma size (Table I).
In SCH-II and III, placental abruption (4.5% and 14.3% vs. 0.9%, respectively, p = 0.002) and early pregnancy loss (12.7% and 42.9%, respectively) respectively – 3.4% vs., p < 0.001) were significant. more common groups relative to the control group (Table I).
Subchorionic Hemorrhage — The Southern Bella
<37 weeks of gestation at delivery in the SCH III group (85.7% vs. 17.0% in SCH I, 21.8% in SCH II and 12.9% in the control group, p < 0.001), vaginal bleeding in the first trimester (76, 2). ) was significantly higher. 21.3% vs. In SCH I, 36.4% in SCH-II and 6.0% in control groups, p <0.001), early pregnancy loss (42.9% in SCH-I vs. 8.5%, 12.7% in SCH-II). and 3.4% in the control group, p <0.001), IUGR (23.8% in SCH-I vs. 2.1% in SCH-II, 5.5% and 3.1% in the control group, p = 0.003) and premature delivery (42.9%). vs. 8.5% in SCH-I, 10.0% in SCH-II and 9.1% in the control group, p <0.001 compared to the SCH-I and II groups, as well as the control group (Table I).
No significant differences were observed between the study groups in terms of age, SCH location, drugs before diagnosis, parity, smoking, mode of delivery, gestational diabetes, preeclampsia, and intrauterine death (Table I).
First-trimester vaginal bleeding, early pregnancy loss, IUGR, and placental delivery increased with increasing SCH size, and early pregnancy loss was the parameter associated with the greatest increase in risk, depending on hematoma size ( Table II ).
[i] R2 (Cox and Snell: 0.221, Nagelkerke: 0.261, Mc Fadden: 0.132), P model <0.001. Ordinal logistic regression, B – regression coefficients, SE – standard error, IUGR – intrauterine growth restriction.
Placental Abruption And Hemorrhage—review Of Imaging Appearance
Apart from the possibility of early pregnancy loss in anterior (15.7%) and cervical (8.1%) and fundus (7.1%) hematomas (p = 0.046), there was no significant difference in pregnancy outcomes due to hematoma location (Table III).
Our findings were associated with lower gestational age at delivery and higher rates of first-trimester bleeding in pregnant women, regardless of hematoma size, delivery at <37 weeks of gestation, first-trimester vaginal bleeding, early pregnancy loss, and termination. were associated with increased placental SCH size. , IUGR and preterm delivery were observed.
The current study is based on the subjective assessment of hematoma size as a fraction of the size of the gestational sac. With that in mind, this seems remarkable
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