Abstract
ObjectiveTo examine the clinicopathological characteristics of pregnant women who presented with intermittent hemorrhage occurring throughout pregnancy until delivery.MethodA total of 24 women with intermittent hemorrhage occurring throughout pregnancy were categorized into two groups, a group with persistent subchorionic hematoma (PSH) and another with chronic abruption (CA), and the pregnancy outcomes were compared between the two groups. The data were expressed as medians (range).ResultsThere were 18 women in the PSH group and 6 women in the CA group. The median gestational age at delivery was 27.9 (22.1–33.4) weeks in the PSH group and 32.9 (24.3–33.1) weeks in the CA group, revealing a significantly earlier gestational age at delivery in the former group (p = 0.014). The percentage of the women developing acute abruption tended to be higher in the CA group [66.7 % (4/6)] than in the PSH group [26.3 % (5/18)]. Small for gestational age (SGA) infants and neonatal chronic lung disease were seen at high incidences, but only in the PSH group [21.1 % (4/18) and 42.1 % (8/18), respectively].ConclusionPSH was associated with earlier gestational age at delivery, a higher incidence of SGA infants, and poorer pregnancy outcomes than CA.
Highlights
Pregnant women are occasionally encountered in clinical settings, in whom hemorrhage occurs intermittently throughout pregnancy until delivery and abruptio placentae is suspected, but no abnormalities are detected on fetal heart rate monitoring making both diagnosis and treatment difficult
A total of 24 women with intermittent hemorrhage occurring throughout pregnancy were categorized into two groups, a group with persistent subchorionic hematoma (PSH) and another with chronic abruption (CA), and the pregnancy outcomes were compared between the two groups
Pregnant women who met the following criteria were defined as having persistent hemorrhage requiring expectant management: (1) intermittent hemorrhage persisting during pregnancy until delivery; (2) placenta previa excluded; (3) exclusion of cervical disease as the source of bleeding; (4) expectant management possible; (5) presence of macroscopic retroplacental hematoma detected at delivery; and (6) delivery at 22 weeks of gestation or later
Summary
Pregnant women are occasionally encountered in clinical settings, in whom hemorrhage occurs intermittently throughout pregnancy until delivery and abruptio placentae is suspected, but no abnormalities are detected on fetal heart rate monitoring making both diagnosis and treatment difficult. This condition appears to be most often attributable to chronic abruption, a concept proposed by Naftolin et al [1]. We examined whether or not appropriate tocolysis could be achieved with a tocolytic agent
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