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Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies.

Abstract：

OBJECTIVE:To assess the association of a first-trimester subchorionic hematoma with pregnancy loss in women with singleton pregnancies. METHODS:We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients had routine first-trimester ultrasound scans. We reviewed ultrasound data from the first ultrasound scan performed between 6 0/7 and 13 6/7 weeks of gestation and compared rates of pregnancy loss before 20 weeks in women with and without a subchorionic hematoma. Logistic regression analysis was used to control for potential confounding variables. RESULTS:From January 2015 to December 2017, a total of 2,446 women met inclusion criteria, 451 (18.4%) of whom had subchorionic hematomas. Women with subchorionic hematomas had their first ultrasound scans at an earlier gestational age (8 5/7 vs 9 6/7 weeks of gestation, P<.001) and were more likely to have vaginal bleeding (33.3% vs 8.1%, P<.001). Maternal age, race, use of in vitro fertilization, body mass index, prior number of losses, and medical comorbidities did not differ between the groups. On univariable analysis, subchorionic hematoma was associated with an increased risk of pregnancy loss before 20 weeks of gestation (7.5% vs 4.9%, P=.026); however, after adjusting for gestational age and vaginal bleeding, this association was no longer significant (adjusted odds ratio 1.13, 95% CI 0.74-1.74). In the 451 women with subchorionic hematomas, no characteristics of the subchorionic hematoma, including size by volume, largest diameter, presence of vaginal bleeding, and presence of an additional subchorionic hematoma, were associated with pregnancy loss. Post hoc power analysis showed we had 80% power to detect an increase in pregnancy loss before 20 weeks of gestation from 4.9% in women with no subchorionic hematoma to 8.3% in women with subchorionic hematoma. CONCLUSION:In this cohort of women with singleton pregnancies, subchorionic hematoma before 14 weeks of gestation was not independently associated with pregnancy loss before 20 weeks of gestation.

journal_name

Obstet Gynecol

journal_title

Obstetrics and gynecology

authors

Naert MN,Khadraoui H,Muniz Rodriguez A,Naqvi M,Fox NS

doi

10.1097/AOG.0000000000003360

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

276-281

issue

eissn

0029-7844

issn

1873-233X

pii

00006250-201908000-00010

journal_volume

134

pub_type

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Association Between First-Trimester Subchorionic Hematomas and Pregnancy Loss in Singleton Pregnancies.