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Grand Rounds

Is Subchorionic Hematoma in the First Trimester Associated with Adverse Outcomes Beyond 20 Weeks?

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BACKGROUND AND PURPOSE:

  • Naert et al. (Obstetrics & Gynecology, 2019) sought to determine whether first-trimester subchorionic hematomas are associated with adverse outcomes >20 weeks

METHODS:

  • Retrospective cohort study
  • Participants
    • Singleton pregnancies
    • First prenatal visit <14 weeks
  • Adverse outcomes
    • Gestational age at delivery | Preterm birth
    • Birth weight | Birth weight <10th percentile
    • Gestational hypertension | Preeclampsia
    • Abruption
    • IUFD >20 weeks
    • Cesarean delivery
    • Blood transfusion
    • Antepartum admissions
  • Study design
    • All patients had first-trimester ultrasound
    • Adverse pregnancy outcomes > 20 weeks compared between women with and without subchorionic hematomas
  • Statistical analysis
    • Regression analysis used to adjust for confounding  
    • 80% power to detect a 5% absolute difference in the frequency of preterm birth (from 10% to 15%)

RESULTS:

  • 2,172 women included
    • subchorionic hematoma: 17.9% | Mean largest diameter 2.1±1.4 cm
  • No differences found for the following
    • Maternal age | Race | IVF | BMI | Medical comorbidities
  • In subchorionic hematoma cohort
    • First ultrasound performed earlier in gestation
      • 8w5d vs 9w6d (P<0.001)
    • Vaginal bleeding was more common  
      • 31.9% vs 7.9% (P<0.001)
  • Univariate analysis and subsequent regression analysis did not show association between subchorionic hematoma and adverse pregnancy outcome
  • However, vaginal bleeding (adjusted for subchorionic hematoma and gestational age at ultrasound examination) was independently associated with
    • Preterm birth (<37 weeks of gestation)
    • Birth weight <10th percentile

CONCLUSION:

  • First trimester subchorionic hematomas in singleton pregnancy is not associated with adverse pregnancy outcomes at more than 20 weeks gestation

Learn More – Primary Sources:

Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies

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Related ObG Topics:

Predicting Pregnancy Loss Due to Subchorionic Hematoma
PRISM Trial Results: Does Progesterone for Bleeding Early in Pregnancy Prevent Pregnancy Loss?
Does a Nationwide Ultrasound Screening Program Improve Detection of Congenital Heart Defects?

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