Abstract
ObjectiveTo evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.MethodsA literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH.ResultsIt is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial.ConclusionsBoth the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy.
Highlights
Intrauterine hematoma (IUH) is a common phenomenon on routine obstetric ultrasonography, especially in the first trimester of gestation
Some studies hypothesized that the presence of IUH is strongly associated with adverse events during pregnancy, including gestational hypertension, pre-eclampsia, placenta abruption, preterm delivery (PTD), small for gestational age (SGA) and low 5-min Apgar score [4]
IUH was divided into three types according to their locations [8,10]: subchorionic (SCH, between the myometrium and the placental membranes and/or at the margin of the placenta, 81%, Figure 1), retroplacental, and preplacental Because of the low incidence of preplacental type, and most discussions focused on the first two types in published literatures, we reviewed subchorionic and retroplacental hematomas in this article
Summary
Intrauterine hematoma (IUH) is a common phenomenon on routine obstetric ultrasonography, especially in the first trimester of gestation. A number of studies have sought to identify the adverse outcomes at the presence of IUH in pregnancies, but only a few systematic reviews have been made. A recent meta-analysis demonstrated that the SCH was associated with an increased risk of early and late pregnancy loss, abruption, and preterm premature rupture of membranes, covering only seven cohort or case-control studies [7]. Both of the two reviews described the association of SCH between with pregnancy complications. The aim of this article was to systematically review the literatures on the relevant symptoms of a hematoma associated with pregnancy complications
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