PREGNANCY OUTCOME AFTER FIRST TRIMESTER INTRAUTERINE HEMATOMA IN ASYMPTOMATIC WOMEN
Mona Mostafa, Omneya Mostafa Halal, Rasha Kamel, Hala Abd El-Wahab, Ahamed M. Gazzar
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University
Objective: The aim of our study was to investigate the role of subchorionic and retro-placental hematoma observed in the first trimester of a viable pregnancy as a predictive factor of adverse outcome.
Design: A prospective observational study.
Setting: Department of Obstetrics and Gynaecology, Cairo University, Egypt.
Participants: Pregnant women in the first trimester who attended the antenatal clinic in Kasr El Aini Hospital and underwent routine 1st trimesteric ultrasound were recruited for participation in this study. All cases had an abdominal ultrasound performed using a 3.5 MHz convex. A hematoma was defined as an anechoic area that has a falciform shape, which is usually observed behind or below the gestational sac. 91 women with intrauterine hematomas formed the study group while 1254 healthy pregnant women in their first trimester formed the control group. The selected patients were followed by our investigative team until delivery or pregnancy termination .The volume of the gestational sac and hematomas were estimated by measuring the maximum transverse, antero-posterior and longitudinal diameters, multiplying these values by a constant of 0.52. We stratified the hematoma volumes as small (less than 20% of gestational sac volume), medium (20-50% of gestational sac volume) and large (more than 50% of gestational sac volume). The outcome of pregnancy was defined as adverse if one of the following conditions occurred: Spontaneous abortion, Fetal growth restriction, Preeclampsia, Preterm delivery, Placental abruption or Fetal distress during labor.
Results: Our results show that patients with intrauterine hematomas were significantly more likely to suffer from complications during pregnancy (5.6 times) than controls. The most significant complications included spontaneous abortion (6.6 fold greater risk), preeclampsia (7.4 fold greater risk), intrauterine fetal growth restriction (7.5 fold greater risk) and preterm delivery (5.6 fold greater risk).
Conclusion: Our study shows that the presence of a subchorionic or retro-placental hematoma during first trimesteric ultrasound examination identifies a subset of patients at increased risk of adverse pregnancy outcome. These patients require enhanced surveillance during pregnancy for the early diagnosis and proper management of possible complications.