Subchorionic hematoma and pregnancy outcomes in patients with threatened miscarriage

Sumaira Naz,Ayesha Malik,Tahira Naru,Sheikh Irfan

doi:10.12669/pjms.38.3.4283

Sumaira Naz, Ayesha Malik + Show 2 more

Open Access

https://doi.org/10.12669/pjms.38.3.4283

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Abstract

Objective:To compare maternal and perinatal outcomes in patients with threatened miscarriage with or without subchorionic hematoma (SCH) at a tertiary care hospital.Methods:This retrospective cohort study was conducted at Aga Khan University Hospital. The study included 200 patients of <20 weeks singleton pregnancy with threatened miscarriage from January 2016 till December 2018. These patients were divided into two groups based on the presence (study group) or absence of subchorionic hematoma (control) on ultrasound imaging. Baseline demographic data, and obstetric outcomes were compared for the two groups.Results:The incidence of subchorionic hematoma was observed to be 30.5% (61/200). Most of the patients of SCH and non SCH groups presented in first trimester. Age and BMI were similar for both groups however there were more multigravida patients in the SCH group (63%versus 46.7%, P=0.12). A higher number of patients in the SCH group ended up in spontaneous miscarriage in contrast to patients with no SCH (13%versus6.1%, P=0.07) and also had a greater proportion of small for gestational age (SGA) babies (8.9%versus3.9%) though no statistical significance was observed. There were more preeclamptic patients in SCH group as compared to non SCH group (4.8%versus0.7%) and the trend was statistically significant(P=0.05). However, no significant correlation of hematoma size and adverse pregnancy outcomes was found in SCH group.Conclusion:Our study shows that women with threatened miscarriage having SCH are at a higher risk of having preeclampsia and SGA and hence these pregnancies warrant greater surveillance.

Highlights

Threatened miscarriage is the most common complication in the first half of pregnancy affecting 20-25% of women.[1]
Sixty-one patients had sonographic evidence of Subchorionic hematoma (SCH) while 139 patients were without hematoma
Our study showed that greater proportion of women in the hematoma group had small for gestational age (SGA) fetuses compared to their non-hematoma counterparts whereas, previous studies regarding SGA as an outcome have conflicting results

Summary

INTRODUCTION

Threatened miscarriage is the most common complication in the first half of pregnancy affecting 20-25% of women.[1]. Controversies exist regarding the correlation of SCH volume, and the simultaneous presence of vaginal bleeding with adverse obstetric outcomes.[8] Pedersen and Mantoni[12] stated that presence of large hematomas does not affect pregnancy outcomes whereas Bennett et al.[13] highlighted that factors like maternal age, size of the hematoma, and gestational age affects fetal outcome. These conflicting results emphasized the need to consider whether it’s the occurrence of first trimester bleed or the presence of subchorionic hematoma that augments the risk for adverse outcomes in threatened miscarriage. This study will help to comprehend any added risks to patients with SCH and threatened miscarriage and provide an insight to the care givers to counsel these patients for anticipated adverse outcomes

METHODS

RESULTS

DISCUSSION