First trimester subchorionic hemorrhage is not associated with adverse pregnancy outcomes after in vitro fertilization

Abstract

Prior work demonstrates adverse associations between incidental subchorionic hemorrhage (SCH) detected on ultrasound and outcomes in naturally occurring pregnancies. However, ultrasound is often performed earlier in gestation with in vitro fertilization (IVF) pregnancies than in natural conceptions. Our objective was to determine the association between incidental SCH on ultrasound and outcomes in IVF pregnancies. retrospective cohort study. Women were identified from a first-trimester ultrasound database kept for IVF pregnancies from 2009 to 2017. Inclusion criteria were fresh or frozen autologous transfer after IVF with a viable pregnancy on first trimester ultrasound. Exclusion criteria were absence of heartbeat on ultrasound and multiple gestation pregnancy. Exposure and covariates included SCH, age, BMI, race, history of prior live birth, fresh vs frozen cycle, day 3 or day 5 transfer, number of embryos transferred, and interpregnancy interval. The primary outcome was live birth and secondary outcomes included preterm delivery and infant weight at delivery. Appropriate statistics were used for univariate analyses. A logistic regression model was built to further investigate associations between significant covariates and outcomes. All analyses were performed in SPSS. 639 women met criteria and 17.8% had a SCH. In univariate analysis. SCH was not associated with live birth whereas increasing maternal age (34.9 vs. 32.9, p<0.001) was negatively associated with live birth. In regression analysis, increasing maternal age remained significant, (OR 0.90, CI 0.83-0.96). No associations were found between SCH or the covariates and preterm birth or fetal weight. Incidentally detected subchorionic hemorrhage on first trimester ultrasound is not associated with fetal birth weight or probability of live birth or preterm birth after IVF. This information may be reassuring to IVF patients with SCH and otherwise viable pregnancy noted on first trimester ultrasound.