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Hernandez-Andrade E, Gerulewicz D, Soto-Torres E, Amro FH, Oyelese Y, Papanna R, Sibai BM, Blackwell SC. We Should Perform a Systematic Evaluation of the Placenta. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025; 44:955-964. [PMID: 39785666 DOI: 10.1002/jum.16645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 12/28/2024] [Indexed: 01/12/2025]
Abstract
Despite its critical importance, the placenta receives substantially less attention during obstetric ultrasound examinations compared to the fetus. The evaluation of the placenta is typically limited to determining its location within the uterus, particularly its relationship to the cervix. Abnormal placenta findings are the result of gross anomalies identified by chance during obstetric examinations, rather than from a systematic evaluation. Here we describe a standardized protocol evaluating four placental regions: 1) the uterine wall/decidua/chorion interface; 2) the amnion/chorion interface; 3) the placental body; and 4) cord insertion and marginal area, which can improve the identification of placental anomalies in all pregnant subjects.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Donatella Gerulewicz
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Eleazar Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Farah H Amro
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Yinka Oyelese
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramesha Papanna
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Baha M Sibai
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Sean C Blackwell
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, USA
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Wei W, Qiu XC, Tang N, Liang Z, Wu J, Huang P. Incidence of subchorionic hematoma and contributing factors in assisted reproductive technologies-a retrospective cohort study. Front Med (Lausanne) 2025; 12:1569789. [PMID: 40337279 PMCID: PMC12055540 DOI: 10.3389/fmed.2025.1569789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Accepted: 04/07/2025] [Indexed: 05/09/2025] Open
Abstract
Background To explore the incidence of subchorionic hematoma (SCH) in IVF-ET (In vitro fertilization-embryo transfer, IVF-ET) fresh, IVF-FET (In vitro fertilization-freeze-thaw embryo transfer, IVF-FET), PGT-FET (preimplantation genetic testing-freeze-thaw embryo transfer, PGT-FET), AIH (artificial insemination by husband, AIH), and natural pregnancy (NP), and to analyze contributing factors. Methods This is a retrospective cohort study. Patients were included: IVF-fresh ET, IVF-FET, PGT-FET, AIH, and NP patient groups. The incidence of SCH in different ART and effect of SCH on pregnancy outcome were compared, Further, multivariate analyses of the occurrence of SCH were conducted. Results The incidence of SCH with IVF-fresh ET, IVF-FET, PGT-FET, AIH and NP was 27.50%, 22.56%, 16.86%, 12.95%, and 13.02%, respectively. Compared with the incidences of SCH with AIH and NP that for IVF-fresh ET and IVF-FET transfer were significantly increased (p < 0.05). The occurrence of SCH was not significantly associated with miscarriage and was significantly negatively correlated (p < 0.05) with high-quality embryos. Conclusion The incidence of SCH in ET was increased compared with that in the Not ET groups, especially after fresh ET. ET unavoidably seems to contribute to the development of SCH; however, it does not affect the pregnancy outcome.
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Affiliation(s)
- Wei Wei
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
| | - Xue Chang Qiu
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
| | - Ni Tang
- Center of Reproductive Medicine, Guangzhou Women and Children’s Medical Center-Liuzhou Hospital, Liuzhou, Guangxi, China
| | - Zhuo Liang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jinxiang Wu
- Department of Reproductive Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Pinxiu Huang
- Center of Reproductive Medicine, The First Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
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Cang R, Ding X, Tian Z, Fu Z, He M, Liang Y. Impact of Subchorionic Hematoma on Pregnancy Outcomes in Obstetric Antiphospholipid Syndrome. Int J Womens Health 2025; 17:855-863. [PMID: 40123753 PMCID: PMC11929509 DOI: 10.2147/ijwh.s496848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 02/17/2025] [Indexed: 03/25/2025] Open
Abstract
Objective This study aimed to investigate the effects of subchorionic hematoma (SCH) in patients with obstetric antiphospholipid syndrome (OAPS) on pregnancy outcomes, as well as the clinical value of anticoagulant therapy. Methods This retrospective study included 109 OAPS patients treated at the Fourth Hospital of Shijiazhuang from December 2019 to December 2021. Patients were divided into two groups: SCH group (n=40) and non-SCH group (n=69). Baseline data, laboratory indicators (anti-β2GP I, lupus anticoagulant, ACL, D-D, AA, ADP, ATIII, PS, and PC), complications, and pregnancy outcomes were compared between the groups. Results There were no significant differences between the two groups concerning the abortion rate, live birth rate (all P>0.05). However, we reported a significantly higher rate of preterm delivery occurring between 34-37 in the SCH group (13.7% vs 1.7%, P=0.027). The proportion of patients with triple-positive antiphospholipid antibodies (aPLs) was significantly higher in the SCH group compared to the non-SCH group (7.5% vs 0.0%, P=0.047). During pregnancy but before routine first-trimester therapy was initiated, the levels of β2GP I, LA, ACL, D-D, AA, and ADP in the SCH group were higher than those in the non-SCH group, while ATIII, PS, and PC levels were lower (all P < 0.05). After treatment, the levels of β2GP I, LA, ACL, D-D, AA, and ADP decreased in both groups compared to their pre-treatment levels (all P < 0.05); however, the levels of D-D and PS in the SCH group remained higher than those in the non-SCH group (all P < 0.05). Conclusion In patients with OAPS who present with SCH during pregnancy, laboratory indicators suggest more severe immune disorders and coagulopathy, as well as an increased risk of preterm delivery.
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Affiliation(s)
- Rong Cang
- Department of Gynecological Endocrinology, The Fourth Hospital of Shijiazhuang (Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University), Shijiazhuang, Hebei, People’s Republic of China
| | - Xuelei Ding
- Department of Gynecological Endocrinology, The Fourth Hospital of Shijiazhuang (Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University), Shijiazhuang, Hebei, People’s Republic of China
| | - Zan Tian
- Department of Dermatology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei, People’s Republic of China
| | - Zijie Fu
- Department of Gynecology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Meijuan He
- Department of Gynecological Endocrinology, The Fourth Hospital of Shijiazhuang (Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University), Shijiazhuang, Hebei, People’s Republic of China
| | - Ying Liang
- Department of Reproductive Medicine, The Fourth Hospital of Shijiazhuang (Obstetrics and Gynecology Hospital Affiliated to Hebei Medical University), Shijiazhuang, Hebei, 050011, People’s Republic of China
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Demir SC, Polat İ, Şahin D, Gedikbaşı A, Çetin C, Timur H, Tanaçan A. PERİDER-TJOD joint review on threatened abortion and guideline for its treatment. Turk J Obstet Gynecol 2025; 22:96-105. [PMID: 40062715 PMCID: PMC11894778 DOI: 10.4274/tjod.galenos.2025.36926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
Objective Although there are several guidelines in the literature on "recurrent abortion", there is no comprehensive guideline on "threatened abortion". The overall purpose of this guideline is to provide healthcare providers with the best available evidence for examination and treatment of pregnant women with threatened abortion. Materials and Methods The scope of the guideline and the first version of the questions were prepared by the Perinatology and High Risk Pregnancies Association (PERİDER) guideline development group in January 2024. Meetings were held to discuss key questions and redefine them. A final list of 8 key questions was created. Keywords were defined for each question and ranked in order of importance and used in searches for all English-language publications in PubMed/Medline and Cochrane libraries. These databases were thoroughly scanned for publications that were published until February 1, 2024. Literature reviews were conducted as an iterative process. In the first step, systematic reviews and meta-analyses were collected. If no results were found, the research was expanded to randomized controlled trials and then to cohort studies and case reports, following the hierarchy of evidence levels. Results This guideline was presented to the board of directors of the Turkish Gynecology and Obstetrics Society (TJOD). With their suggestions, guideline was finalized, and it was decided to be published as a joint guideline of PERİDER-TJOD. Conclusion This guideline provides an overview of threatened abortion and the recommended treatments. In addition, by recognizing the deficiencies in the literature, suggestions were made regarding research that could help clinicians' decisions in the future.
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Affiliation(s)
- Süleyman Cansun Demir
- Çukurova University Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Perinatology, Adana, Türkiye
| | - İbrahim Polat
- Başakşehir Çam ve Sakura City Hospital, Clinic of Gynecology and Obstetrics, Perinatology Unit, İstanbul, Türkiye
| | - Dilek Şahin
- Ankara Bilkent City Hospital, Clinic of Gynecology and Obstetrics, Perinatology Unit, Ankara, Türkiye
| | | | - Cihan Çetin
- Bahçeşehir University Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Perinatology, İstanbul, Türkiye
| | - Hakan Timur
- Ordu University Gynecology and Children’s Hospital, Clinic of Gynecology and Obstetrics, Perinatology Unit, Ordu, Türkiye
| | - Atakan Tanaçan
- Ankara Bilkent City Hospital, Clinic of Gynecology and Obstetrics, Perinatology Unit, Ankara, Türkiye
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Aktemur G, Tokgöz Çakır B, Sucu S, Karabay G, Şeyhanlı Z, Vanlı Tonyalı N, Diktaş EG, Ünsal M, Erkaya S. Does Corpus Luteum Doppler Have a Role in Prognostic Prediction for Outcome with Threatened Abortion? J Clin Med 2025; 14:1419. [PMID: 40094848 PMCID: PMC11899976 DOI: 10.3390/jcm14051419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/17/2025] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: This study evaluated the prognostic value of corpus luteum Doppler findings in predicting pregnancy outcomes in patients with threatened abortion, with or without subchorionic hemorrhage. Methods: A prospective cohort study included 180 pregnant women diagnosed with threatened abortion in the first trimester-120 without subchorionic hemorrhage and 60 with subchorionic hemorrhage. Corpus luteum Doppler parameters, including systole/diastole ratio, Resistance Index, and Pulsatility Index, were measured via transvaginal ultrasonography. Pregnancy outcomes were categorized as first-trimester abortion or continuation into the second trimester. Results: Corpus luteum Doppler parameters were significantly higher in patients with first-trimester abortion compared to those with ongoing pregnancies (p < 0.001). Among patients with subchorionic hemorrhage, those who experienced abortion also showed higher Doppler values (p < 0.001). ROC analysis indicated that corpus luteum Doppler parameters effectively predicted first-trimester abortion, with a systole/diastole ratio > 2.87 achieving 77% sensitivity and 75% specificity (AUC = 0.767, p < 0.001). Conclusions: Corpus luteum Doppler is a valuable, non-invasive tool for predicting pregnancy outcomes in threatened abortion, particularly with subchorionic hemorrhage. Increased resistance in Doppler parameters may indicate luteal insufficiency and reduced progesterone levels. Larger studies are needed to confirm these findings and explore underlying mechanisms.
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Affiliation(s)
- Gizem Aktemur
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | - Betül Tokgöz Çakır
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | - Sadun Sucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | - Gülşan Karabay
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | - Zeynep Şeyhanlı
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | - Nazan Vanlı Tonyalı
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, 06170 Ankara, Turkey; (B.T.Ç.); (S.S.); (G.K.); (Z.Ş.); (N.V.T.)
| | | | - Mehmet Ünsal
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey; (M.Ü.); (S.E.)
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, 06800 Ankara, Turkey; (M.Ü.); (S.E.)
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Matar M, Yared G, Massaad C, Ghazal K. Vaginal bleeding during pregnancy: a retrospective cohort study assessing maternal and perinatal outcomes. J Int Med Res 2025; 53:3000605251315349. [PMID: 39921410 PMCID: PMC11806467 DOI: 10.1177/03000605251315349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 01/07/2025] [Indexed: 02/10/2025] Open
Abstract
OBJECTIVE Vaginal bleeding is a relatively common problem during pregnancy, with up to 25% of women experiencing some level of bleeding or spotting during pregnancy. Although not always a concern, pregnancy-related vaginal bleeding may detrimentally impact maternal and fetal health, and can arise at any stage during the pregnancy, usually linked with preterm labor, miscarriage, placental abnormalities, or implantation bleeding. As vaginal bleeding may compromise newborn health outcomes, for example, leading to low birth weight and neonatal intensive care unit (NICU) hospitalizations, it is imperative to understand the etiology of the bleed and effectively manage the patient's condition. Thus, the aim of this study was to evaluate the prognostic value of vaginal bleeding as an indicator for at-risk pregnancies, aiming to elucidate its association with perinatal outcomes and pregnancy complications. METHODS Consecutive pregnant female patients, aged 16-47 years, were included in this retrospective cohort study, and categorized into those with or without pregnancy-associated bleeding. Between-group differences and correlations in pregnancy complications and perinatal outcomes were statistically analyzed. RESULTS Among a total of 441 patients, the incidence of vaginal bleeding was 74.4%, predominantly occurring in the first trimester (67.1%). No significant association was found between bleeding and maternal age, parity, abortion history, or total number of pregnancies. Educational level varied, with 64.9% of moderate education level experiencing bleeding. Pre-pregnancy comorbidities, such as diabetes, hypertension, and hypothyroidism, were not significantly correlated with bleeding. However, a history of infertility and progesterone treatment during pregnancy was significantly associated with bleeding episodes. An increased risk for NICU admissions and conditions such as respiratory distress in neonates was found, alongside a significant association with post-delivery bleeding and premature labor in the later trimesters. CONCLUSIONS Vaginal bleeding during pregnancy was not found to be significantly associated with maternal age, parity, abortion history, or total pregnancies. Nonetheless, the findings suggest a significant relationship between bleeding episodes and a history of infertility or progesterone treatment during pregnancy. Additionally, pre-pregnancy comorbidities, including diabetes, hypertension, and hypothyroidism were not associated with pregnancy bleeding. However, the latter was associated with increased risk of post-delivery bleeding, premature labor, and neonatal complications, such as respiratory distress and NICU admissions.
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Affiliation(s)
- Maroun Matar
- Department of Pediatrics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Georges Yared
- Department of Obstetrics and Gynecology, The Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Christopher Massaad
- Faculty of Medicine, Saint George University of Beirut, Rmeil, Beirut, Lebanon
| | - Kariman Ghazal
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, The Lebanese University, Beirut, Lebanon
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Yasuda E, Kawamura Y, Ueda Y, Takakura M, Matsuzaka Y, Matsuzaka S, Inohaya A, Chigusa Y, Mandai M, Mogami H. Potential mechanisms for chorioamniotic membrane rupture after subchorionic hematoma. Am J Obstet Gynecol 2025:S0002-9378(25)00064-X. [PMID: 39892838 DOI: 10.1016/j.ajog.2025.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 01/17/2025] [Accepted: 01/24/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND Subchorionic hematoma is a risk factor for preterm prelabor rupture of membranes and preterm birth. A small proportion of persistent subchorionic hematoma leads to a chronic abruption-oligohydramnios sequence. OBJECTIVE To determine the mechanism by which subchorionic hematomas may damage chorioamniotic membranes. STUDY DESIGN 1) The number and subtype of macrophages were determined by immunohistochemistry in chorioamniotic membranes from 8 subchorionic hematoma patients who delivered preterm (25.5 (24-32) weeks of gestation (median and range)) and 6 gestational age-matched control patients (25.5 (25-28) weeks of gestation (median and range)). Further, the thickness and fibrosis of the membranes were quantified. 2) We also developed an intrauterine hematoma model in pregnant mice, and the effects of hematoma on the amnion were analyzed by histology and immunofluorescence. 3) In vitro, primary human amnion mesenchymal cells were cocultured with M2-differentiated macrophages, and changes in mesenchymal cells were analyzed. RESULTS 1) Subchorionic hematoma increased the number of iron-laden macrophages in the human amnion. These macrophages were CD206+, a marker of macrophages required for the maintenance of homeostasis, tissue remodeling, and metabolic adaptations. The collagen layer of the amnion tended to be thickened in patients with subchorionic hematoma. Interestingly, α-smooth muscle actin+ myofibroblasts were increased in the amnion mesenchymal layer in patients with subchorionic hematoma. Vimentin, a mesenchymal marker, was expressed in the epithelial layer of the hematoma amnion. Together, these findings indicate epithelial-mesenchymal transition in the amnion of membranes from pregnancies with subchorionic hematomas. 2) These findings in human amnion were confirmed in a mouse model of intrauterine hematoma. 3) Further, in vitro, coculture of human amnion mesenchymal cells with M2-differentiated human macrophages resulted in transformation of these cells into α-smooth muscle actin-expressing myofibroblasts via the TGF-β‒Smad3 pathway. CONCLUSION Subchorionic hematoma induces migration of macrophages to chorioamniotic membranes which activate the transition of amnion mesenchymal cells to myofibroblasts. These myofibroblasts may contribute to fibrosis of the amnion and damage chorioamniotic membranes.
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Affiliation(s)
- Eriko Yasuda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Kawamura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Ueda
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahito Takakura
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Matsuzaka
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sunao Matsuzaka
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Asako Inohaya
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Lou Y, Chen G, Wang L, Zhao X, Ma J. Association between first-trimester subchorionic hematoma and pregnancy loss before 20 weeks of gestation in singleton pregnancies. Sci Rep 2024; 14:30034. [PMID: 39627519 PMCID: PMC11615346 DOI: 10.1038/s41598-024-81759-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 11/28/2024] [Indexed: 12/06/2024] Open
Abstract
To evaluate the association between a first-trimester subchorionic hematoma (SCH) and pregnancy loss before 20 weeks of gestation in singleton pregnancies. We conducted a retrospective cohort study of singleton pregnancies from January to December 2021. All patients had routine first-trimester ultrasound scans and were followed up for pregnancy outcomes. We compared pregnancy loss rates before 20 weeks in women with and without SCH and analyzed risk factors using logistic regression. Out of 1,144 singleton pregnancies, 559 (48.9%) had SCH. Women with SCH had higher rates of vaginal bleeding (38.1 vs. 23.2%, P < 0.001). SCH was independently associated with miscarriage before 20 weeks (adjusted OR 1.94, 95% CI 1.19-3.15). Earlier SCH diagnosis increased miscarriage risk (adjusted OR 2.71 for diagnosis before 7 weeks, 95% CI 1.45-5.07). SCH size was not linked to pregnancy loss, but "large" SCH increased placental abruption risk (adjusted OR 5.03, 95% CI 1.20-21.11). Dydrogesterone use appeared protective against miscarriage (adjusted OR 0.28, 95% CI 0.15-0.52). First-trimester SCH is associated with an increased risk of miscarriage before 20 weeks. Large SCHs increase the risk of placental abruption, while dydrogesterone use may reduce miscarriage risk.
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Affiliation(s)
- Ying Lou
- Obstetrics and Gynecology Department, Yuyao People's Hospital, 800St Chengdong Road, Yuyao, 315400, Zhejiang, China
| | - Guili Chen
- Obstetrics and Gynecology Department, Yuyao People's Hospital, 800St Chengdong Road, Yuyao, 315400, Zhejiang, China
| | - Lanying Wang
- Obstetrics and Gynecology Department, Yuyao People's Hospital, 800St Chengdong Road, Yuyao, 315400, Zhejiang, China
| | - Xiaoqing Zhao
- Obstetrics and Gynecology Department, Yuyao People's Hospital, 800St Chengdong Road, Yuyao, 315400, Zhejiang, China
| | - Jianting Ma
- Obstetrics and Gynecology Department, Yuyao People's Hospital, 800St Chengdong Road, Yuyao, 315400, Zhejiang, China.
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Karimi A, Sayehmiri K, Vaismoradi M, Dianatinasab M, Daliri S. Vaginal bleeding in pregnancy and adverse clinical outcomes: a systematic review and meta-analysis. J OBSTET GYNAECOL 2024; 44:2288224. [PMID: 38305047 DOI: 10.1080/01443615.2023.2288224] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
Background: Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis.Methods: Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS).Results: A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4).Conclusions: Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.
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Affiliation(s)
- Arezoo Karimi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kourosh Sayehmiri
- Prevention Center of Social-Mental injuries, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Mostafa Dianatinasab
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
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Shi J, Wu L, Xu Z, Lou X. Association between subchorionic hematoma in the first trimester and outcomes of singleton pregnancies achieved through assisted reproductive technology: a systematic review and meta-analysis. J Assist Reprod Genet 2024; 41:2549-2556. [PMID: 39026123 PMCID: PMC11535082 DOI: 10.1007/s10815-024-03181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To evaluate the association between first trimester (≤ 12 weeks gestation) subchorionic hemorrhage (SCH), and maternal and neonatal outcomes in women who conceived with the help of assisted reproductive technique (ART). METHODS PubMed, Embase, Web of Science, and Scopus databases were searched for observational studies that specifically focused on women who achieved pregnancy via ART and investigated the relationship between early pregnancy (within 12 weeks of gestation) SCH and maternal and neonatal outcomes. Only studies with singleton pregnancies and reporting data on the comparator group (women without SCH) were included. Primary outcomes of interest included incidences of early (within 20 weeks of gestation) pregnancy loss, preterm delivery, caesarean section, and live birth rates. Pooled effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI). RESULTS Nine studies were included. All studies had a cohort design. In all studies, the primary assisted reproduction technique used was in-vitro fertilization (IVF). Compared to pregnancies without SCH, women with diagnosed early pregnancy SCH have a similar risk of preterm birth (< 37 weeks) (OR 1.01, 95% CI 0.83, 1.22), low birth weight (< 2500 g) (OR 1.01, 95% CI 0.59, 1.73) and fetal growth restriction (OR 1.57, 95% CI 0.62, 4.02). The gestational age (in weeks) (weighted mean difference (WMD) - 0.06, 95% CI - 0.18, 0.06) and the birth weight (in grams) (WMD - 16.5, 95% CI - 62.9, 29.8) were also similar in the two groups. The odds of early pregnancy loss (OR 1.39, 95% CI 0.97, 2.01), live birth (OR 0.77, 95% CI 0.55, 1.08) and caesarean delivery (OR 0.97, 95% CI 0.81, 1.16) were statistically similar in both groups. The risk of maternal adverse outcomes such as gestational diabetes (OR 0.98, 95% CI 0.74, 1.29), hypertensive disorder (OR 0.95, 95% CI 0.63, 1.43), premature rupture of membranes (PROM) (OR 1.36, 95% CI 0.90, 2.05) and placental abruption (OR 2.44, 95% CI 0.57, 10.5) was also similar in both the groups. There was no evidence of publication bias. CONCLUSION The findings suggest that SCH may not significantly increase the risk of adverse maternal and perinatal outcomes in pregnancies conceived through ART, particularly IVF. TRIAL REGISTRATION PROSPERO registration number CRD42024533996.
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Affiliation(s)
- Juan Shi
- Outpatient Department, Huzhou Maternity and Child Health Care Hospital, Huzhou City, China
| | - Lifang Wu
- Gynaecology Department, Huzhou Maternity and Child Health Care Hospital, Huzhou City, China
| | - Zhuangzhuang Xu
- Obstetrics and Gynaecology Department, Huzhou Maternity and Child Health Care Hospital, Huzhou City, China
| | - Xiaohua Lou
- Outpatient Department, Huzhou Maternity and Child Health Care Hospital, Huzhou City, China.
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Yoshihara T, Okuda Y, Yoshino O. Quantification of the size of subchorionic hematoma causing pregnancy-related complications: a retrospective cohort study. J Med Ultrason (2001) 2024; 51:649-654. [PMID: 39190239 PMCID: PMC11968545 DOI: 10.1007/s10396-024-01488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE This study aimed to establish criteria for defining "large" subchorionic hematoma (SCH) and assess its association with pregnancy complications. METHOD This was a retrospective cohort study conducted at our institution between 2019 and 2020. We compared the size of SCH between the pregnancy-related complication and non-complication groups, using two measurement methods. Receiver operating characteristic (ROC) curve analysis determined cutoff values. Additionally, we compared the occurrence of pregnancy complications among three groups: large SCH group (above the cutoff value), non-large SCH group (below the cutoff value), and non-SCH group. RESULTS Of 1305 singleton pregnancies managed during the study, 80 cases were diagnosed with SCH. Pregnancy complications occurred in 15 patients. The patients with pregnancy complications had significantly larger SCH sizes with both measurement methods. For each method, the cutoff values calculated from the ROC curve analysis were as follows: Method 1, 25% (area under the ROC curve [AUC], 0.662); Method 2, 30% (AUC, 0.624). In Method 1, we found a significantly higher occurrence of preterm delivery in the large SCH group (24.1%) than in the non-large SCH (4.2%) and non-SCH groups (5.3%; all p < 0.01). In Method 2, there was a significantly higher occurrence of preterm delivery in the large SCH group (33.3%) than in the non-large SCH (6.5%) and non-SCH groups (5.3%; all p < 0.01). CONCLUSION Large SCHs may indicate a high risk of pregnancy-related complications. Among these, recognizing and managing cases that exceed the aforementioned cutoff value as high-risk cases may be beneficial for reducing pregnancy complications.
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Affiliation(s)
- Tatsuya Yoshihara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Akay A, Reis YA, Şahin B, Öncü AK, Obut M, İskender C, Çelen Ş. Effect of subchorionic hematoma on first-trimester maternal serum free β-hCG and PAPP-A levels. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo66. [PMID: 39176201 PMCID: PMC11341181 DOI: 10.61622/rbgo/2024rbgo66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/24/2024] [Indexed: 08/24/2024] Open
Abstract
Objective This study aimed to investigate the effects of the presence of subchorionic hematoma (SH) in early pregnancies with threatened miscarriage (TM) on levels of first-trimester maternal serum markers, pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG) levels. Methods The data of TM cases with SH in the first trimester between 2015 and 2021 were evaluated retrospectively. The data of age and gestational age-matched TM cases without SH were also assessed to constitute a control group. Demographic characteristics, obstetric histories, ultrasonographic findings, and free β-hCG and PAPP-A levels of the groups were compared. Results There were 119 cases in the study group and 153 cases in the control group. The median vertical and longitudinal lengths of the SH were 31 mm and 16 mm. The median age of both groups was similar (p=0.422). The MoM value of PAPP-A was 0.088 (.93) in the study group and 0.9 (0.63) in the control group (p=0.519). Similarly, the MoM value of free β-hCG was 1.04 (0.78) in the study group and 0.99 (0.86) in the control group (p=0.66). No significant relationship was found in the multivariate analysis between free β-hCG MoM, PAPP-A MoM, age, gravida, and vertical and longitudinal lengths of the hematoma (p>0.05). Conclusion The level of PAPP-A and free β-hCG were not affected by the SH. Therefore, these markers can be used reliably in TM cases with SH for the first-trimester fetal aneuploidy screening test.
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Affiliation(s)
- Arife Akay
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Bingöl State HospitalDepartment of Obstetrics and GynecologyBingölTurkeyBingöl State Hospital, Department of Obstetrics and Gynecology, Bingöl, Turkey.
| | - Yıldız Akdaş Reis
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Büşra Şahin
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Akçakoca Public HospitalDepartment of Obstetrics and GynecologyDüzceTurkeyAkçakoca Public Hospital, Department of Obstetrics and Gynecology, Düzce, Turkey.
| | - Asya Kalaycı Öncü
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Erciş Şehit Rıdvan Çevik Public HospitalVanTurkeyErciş Şehit Rıdvan Çevik Public Hospital, Van, Turkey.
| | - Mehmet Obut
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Diyarbakir Gazi Yasargil Training and Research HospitalDepartment of PerinatologyDiyarbakırTurkeyDiyarbakir Gazi Yasargil Training and Research Hospital, Department of Perinatology, Diyarbakır, Turkey.
| | - Cantekin İskender
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Etlik City HospitalDepartment of PerinatologyAnkaraTurkeyEtlik City Hospital, Department of Perinatology, Ankara, Turkey.
| | - Şevki Çelen
- Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research HospitalDepartment of Obstetrics and GynecologyAnkaraTurkeyEtlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
- Etlik City HospitalDepartment of PerinatologyAnkaraTurkeyEtlik City Hospital, Department of Perinatology, Ankara, Turkey.
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Wang W, Zhao Q, Liu Y, Guo L, Zhou W, Zhang Q, Yan J, Ni T. The impact of first-trimester subchorionic hematomas on pregnancy outcomes after euploid embryo transfer: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:180. [PMID: 38454339 PMCID: PMC10918983 DOI: 10.1186/s12884-024-06359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The aim of the retrospective cohort study was to investigate the prognostic effect of subchorionic hematomas (SCH) in the first trimester on pregnancy outcomes after euploid embryo transfer. METHODS We retrospectively analyzed women achieving singleton pregnancy by PGT-A or PGT-SR from January 2017 to January 2022. Patients were enrolled in the study if they had a viable intrauterine pregnancy at ultrasound between 6 0/7 and 8 0/7 weeks of gestation. Pregnancy outcomes as well as the incidence of maternal complications were compared between patients with and without SCH. Logistic regression was used for adjusting for potential confounding factors. RESULTS A total of 1539 women were included, of which 298 with SCH and 1241 with non-SCH. The early miscarriage rate in SCH group was significantly higher than that in the non-SCH group (10.1% vs. 5.6%, adjusted odds ratio [aOR] 1.99, 95% confidence interval [CI] 1.25-3.16, P = 0.003). The live birth rate in SCH group was significantly lower than that in the non-SCH group. (85.6% vs. 91.2%, aOR 0.57, 95% CI 0.39-0.84, P = 0.005). In addition, SCH group had an increased risk of hypertensive disorder of pregnancy (HDP) (8.9% vs. 5.2%, P = 0.022), especially in hematoma with bleeding (19.3% vs. 6.0%, P = 0.002). The incidence of gestational diabetes mellitus (GDM), major congenital abnormalities rate, normal birth weight rate and low birth weight rate were similar between the two groups. CONCLUSIONS The presence of SCH in the first trimester was associated with worse pregnancy outcomes after euploid embryo transfer, including an increased risk of early miscarriage and hypertensive disorder of pregnancy, along with a reduced live birth rate.
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Affiliation(s)
- Weilin Wang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Qing Zhao
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Yingbo Liu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Ling Guo
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Wei Zhou
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Qian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Junhao Yan
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Tianxiang Ni
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
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Ge Y, Lai S, Shi J, Li X, Li X, Chu H, Hu K, Li R, Zhao J. Pregnancy outcomes of fetal reduction in patients with intrauterine haematoma following double embryo transfer. Reprod Biomed Online 2024; 48:103644. [PMID: 38215685 DOI: 10.1016/j.rbmo.2023.103644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 01/14/2024]
Abstract
RESEARCH QUESTION Is there an association between intrauterine haematoma (IUH) and pregnancy outcomes in patients who undergo fetal reduction after double embryo transfer (DET), and if so, what is the relationship between IUH-related characteristics and pregnancy outcomes? DESIGN Clinical information and pregnancy outcomes of women who underwent fetal reduction after DET were analysed. Patients with other systematic diseases, ectopic pregnancy or heterotopic pregnancy, monochorionic twin pregnancies and incomplete data were excluded. Stratification of IUH pregnancies was undertaken based on IUH-related characteristics. The main outcome was incidence of fetal demise (<24 weeks), with other adverse pregnancy outcomes considered as secondary outcomes. RESULTS Thirty-four IUH patients and 136 non-IUH patients who underwent fetal reduction after DET were included based on a 1:4 match for age, cycle type and fertilization method. IUH patients had a higher incidence of early fetal demise (20.6% versus 7.4%, P = 0.048), threatened abortion (48.1% versus 10.3%, P<0.001) and postpartum haemorrhage (PPH; 14.8% versus 4.0%, P = 0.043) compared with non-IUH patients. IUH was an independent risk factor for early fetal demise [adjusted OR (aOR) 3.34, 95% CI 1.14-9.77] and threatened abortion (aOR 8.61, 95% CI 3.28-22.61) after adjusting for potential confounders. IUH pregnancies undergoing fetal reduction that resulted in miscarriage had larger IUH volumes and earlier diagnosis (both P < 0.03). However, IUH characteristics (i.e. volume, changing pattern, presence or absence of cardiac activity) were not associated with threatened abortion or PPH. CONCLUSIONS Fetal reduction should be performed with caution in IUH pregnancies after DET as the risk of fetal demise is relatively high. Particular attention should be given to IUH patients with early signs of threatened abortion and inevitable fetal demise.
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Affiliation(s)
- Yimeng Ge
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; Peking University Health Science Centre, Beijing, China
| | - Shaoyang Lai
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jing Shi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xin Li
- Wuhan University of Science and Technology, Wuhan, China
| | - Xiaoxue Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Hongling Chu
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Kailun Hu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Rong Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
| | - Jie Zhao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China; National Clinical Research Centre for Obstetrics and Gynaecology, Beijing, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
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15
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Liang W, Yan X, Shi Y, Chen B, An L, Huang B, He F. Association between graded subchorionic hematoma and adverse pregnancy outcomes in singleton pregnancies: a prospective observational cohort study. Arch Gynecol Obstet 2024; 309:541-549. [PMID: 36821010 PMCID: PMC10808168 DOI: 10.1007/s00404-023-06943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To investigate whether different grades of subchorionic hematoma (SCH) are involved in the timing of birth and the development of adverse pregnancy outcomes in singleton pregnant women. METHODS A total of 171 women with singleton pregnancies, 72 of whom had SCH before 20 weeks and between 12 and 20 weeks of gestational age (GA), were included in this study conducted between January 2018 and December 2021. These patients were divided into three subgroups based on the size of the subchorionic hematoma on ultrasound imaging. Baseline demographic data, obstetric outcomes, and risk factors for subchorionic hematoma were compared for the two groups. RESULTS A higher number of pregnancies from the SCH group resulted in miscarriage (30.56% versus 2.02%, p < 0.0001), early preterm birth (8.33% versus 1.01%, p = 0.0035), premature rupture of membranes (15.28% versus 4.04%, p = 0.0103), fetal growth restriction (9.72% versus 0%, p = 0.0015), and delivery 13.18 days earlier (274.34 ± 11.25 versus 261.16 ± 29.80, p = 0.0013) than those from the control group. Compared with SCH detected before 12 weeks of GA, the rate of miscarriage increased, and the live birth rate decreased significantly in patients with SCH caught between 12 and 20 weeks of GA. With the increase in hematoma size, the likelihood of miscarriage increased significantly. Further analysis found that delivery occurred earlier in the medium/large SCH group (271.49 ± 23.61 versus 253.28 ± 40.68/261.77 ± 22.11, p = 0.0004/0.0073) but not in the small SCH group (274.34 ± 11.25 versus 267.85 ± 21.01, p = 0.2681) compared to the control group. Our results also showed that the anterior placenta (52.04% versus 33.33%, p = 0.0005, OR = 0.3137, 95% CI [0.1585, 0.601]) is a protective factor for subchorionic hematoma. CONCLUSION Our study shows that women with SCH are at a higher risk of adverse pregnancy outcomes and are independently associated with miscarriage, early preterm birth, premature rupture of membranes, and fetal growth restriction. A subchorionic hematoma, especially detected between 12 and 20 weeks of GA, is very likely to cause miscarriage or preterm birth in women with a medium or large subchorionic hematoma.
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Affiliation(s)
- Weizhang Liang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi Yan
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yifu Shi
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bingjun Chen
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luwan An
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bei Huang
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Fang He
- Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Matsuo S, Kotani T, Tano S, Ushida T, Imai K, Nakamura T, Osuka S, Goto M, Osawa M, Asada Y, Kajiyama H. Risk factors for non-previa placenta accreta spectrum in pregnancies conceived through frozen embryo transfer during a hormone replacement cycle in Japan. Reprod Med Biol 2024; 23:e12592. [PMID: 39050787 PMCID: PMC11266119 DOI: 10.1002/rmb2.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Non-previa placenta accreta spectrum (PAS) is associated with assisted reproductive technology (ART), particularly frozen embryo transfer during hormone replacement therapy (HRC-FET). We especially aimed to evaluate the prevalence and risk factors for non-previa PAS in HRC-FET pregnancies. Methods Overall, 279 women who conceived through ART at three ART facilities and delivered at a single center were included in this retrospective study. Data regarding endometrial thickness at embryo transfer, previous histories, and type of embryo transfer-HRC-FET, frozen embryo transfer during a natural ovulatory cycle (NC-FET), and fresh embryo transfer (Fresh-ET)-were collected. Univariable logistic regression analyses were conducted. Results The prevalence of non-previa PAS was 27/192 (14.1%) in the HRC-FET group and 0 (0.0%) in both the NC-FET and Fresh-ET groups. Significantly high odds ratio [95% confidence interval] of non-previa PAS was associated with a history of artificial abortion (6.45 [1.98-21.02]), endometrial thickness <8.0 mm (6.11 [1.06-35.12]), resolved low-lying placenta (5.73 [2.13-15.41]), multiparity (2.90 [1.26-6.69]), polycystic ovarian syndrome (2.62 [1.02-6.71]), and subchorionic hematoma (2.49 [1.03-6.04]). Conclusions A history of artificial abortion, endometrial thickness <8.0 mm, and resolved low-lying placenta may help in antenatal detection of a high-risk population of non-previa PAS in HRC-FET pregnancies.
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Affiliation(s)
- Seiko Matsuo
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Tomomi Kotani
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
- Division of Reproduction and Perinatology, Center for Maternal‐Neonatal CareNagoya University HospitalNagoyaJapan
| | - Sho Tano
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Takafumi Ushida
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
- Division of Reproduction and Perinatology, Center for Maternal‐Neonatal CareNagoya University HospitalNagoyaJapan
| | - Kenji Imai
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Tomoko Nakamura
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
- Division of Reproduction and Perinatology, Center for Maternal‐Neonatal CareNagoya University HospitalNagoyaJapan
| | - Satoko Osuka
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Maki Goto
- Department of Obstetrics and GynecologyOkazaki City HospitalOkazakiJapan
| | | | | | - Hiroaki Kajiyama
- Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
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Du R, Tian Y, Shi AJ, Gu HH, Li YX, Wang M. Is intrauterine hematoma associated with adverse pregnancy and obstetric outcomes of ART singletons? A systematic review and meta-analysis. HUM FERTIL 2023; 26:1553-1561. [PMID: 37257490 DOI: 10.1080/14647273.2023.2213448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/13/2023] [Indexed: 06/02/2023]
Abstract
The objective of our meta-analysis was to estimate the effect of intrauterine hematoma (IUH) on obstetric and pregnancy outcomes of assisted reproductive technology (ART) pregnancies. Four electronic databases were searched up to December 2021 to find studies reporting relevant outcomes of ART pregnancies with IUH. Dichotomous data were expressed as odds ratios (OR) with 95% confidence intervals (CI). Continuous data were expressed as weighted mean difference (WMD) with 95% CI. A total of six observational studies were included in this meta-analysis. Our data suggested that IUH in pregnancies achieved by ART are not associated with increased risks of miscarriage, low birth weight, placenta previa, or premature rupture of membranes. Similar birthweight was noted between the two groups. However, IUH was associated with significantly shorter gestational age at delivery (GA) as well as higher risks of preterm birth. Subgroup analyses have found that the presence of retroplacental haematoma was associated with an increased risk of miscarriage. IUH may be associated with decreased GA and an increased risk of preterm birth. Therefore, Women diagnosed with IUH should be offered increased surveillance during the course of their pregnancy.
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Affiliation(s)
- Rui Du
- Department of Gynecology and Obstetrics, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Ying Tian
- Department of Gynecology, The First Hospital of Harbin, Heilongjiang, China
| | - Ai-Juan Shi
- Department of Gynecology, Chongming Area Maternal and Child Health Hospital, Shanghai, China
| | - Huan-Hua Gu
- Department of Gynecology, Chongming Area Maternal and Child Health Hospital, Shanghai, China
| | - Yi-Xin Li
- Department of Gynecology and Obstetrics, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Mei Wang
- Department of Gynecology, Shanghai Pudong New Area People's Hospital, Shanghai, China
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Gu C, He Y, Li X, Li Q, Xuan Q, Li K. The effects of first-trimester subchorionic hematoma on pregnancy outcomes: a retrospective cohort study. Arch Gynecol Obstet 2023; 308:1159-1164. [PMID: 36100729 DOI: 10.1007/s00404-022-06776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/28/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Although first-trimester subchorionic hematoma (SCH) always concerns expectant parents, its clinical significance remains controversial. This study aimed to examine the relationship between SCH and its association with subsequent miscarriage and other perinatal outcomes in singleton pregnancies. METHODS We conducted a retrospective cohort study including 43,660 women who underwent routine prenatal care since the first trimester and then were followed up for maternal and neonatal outcomes. SCH was detected in the first-trimester ultrasound examinations. Robust Poisson regression was used to estimate adjusted risk associations of SCH with maternal and neonatal outcomes. RESULTS A total of 815 (1.87%) SCH cases were detected in the first-trimester ultrasound examinations. The rate of miscarriage was statistically significantly higher in women with SCH than without [35.21% vs. 23.92%, P < 0.01; adjusted relative risk (RR):1.44, 95% confidence interval (CI): 1.31-1.58]. Subgroup analysis of women with SCH showed a clear trend that the earlier SCH occurred, the higher the risk of miscarriage was [adjusted RR (95% CI) for onset at the gestational weeks of 8-9, 6-7, and < 6 vs. ≥ 10: 1.30 (0.69-2.46), 2.33 (1.28-4.23), and 4.18 (2.30-7.58), respectively; Ptrend < 0.01]. In addition, women with SCH volume ≥ 1 ml showed higher risk than did those with SCH volume < 1 ml [adjusted RR (95% CI) for 1-4.9 ml, and ≥ 5 ml vs. < 1 ml: 1.36 (1.10-1.68) and 1.56 (1.18-2.07), respectively]. There was no statistically significant difference in the rates of other pregnancy outcomes between women with and without SCH. CONCLUSIONS First-trimester SCH, particularly when characterized by early presence and large size, might significantly increase the risk of miscarriage. Data from this study suggest no associations between SCH and other maternal and neonatal outcomes.
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Affiliation(s)
- Chongjuan Gu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yaojuan He
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaojun Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Qingfeng Li
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qingshan Xuan
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kuanrong Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China.
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Pan S, Lan Y, Zhou Y, Chen B, Zhou F, Dai D, Hua Y. Associations between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with singleton pregnancies. BMC Pregnancy Childbirth 2023; 23:555. [PMID: 37532977 PMCID: PMC10394775 DOI: 10.1186/s12884-023-05831-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between the size and duration of asymptomatic subchorionic hematoma and pregnancy outcomes in women with singleton pregnancies. METHODS This was a retrospective study that enrolled 701 singleton pregnant women who were diagnosed with asymptomatic subchorionic hematoma by ultrasound at 5-10 gestational weeks. The control group recruited 640 normal pregnant women without subchorionic hematoma who were matched with subchorionic hematoma group on baseline characteristics. The pregnancy outcomes were compared between the two groups, and the associations of the size and duration of subchorionic hematoma with pregnancy outcomes were analyzed by logistic regression model. RESULTS Compared with the normal pregnancy group, the incidence of, gestational diabetes mellitus, gestational thrombocytopenia, placenta adhesion, fetal growth restriction, macrosomia in subchorionic hematoma group were higher (all P < 0.05). After adjusting for confounding factors, the hematoma size was positively associated with the occurrence of gestational hypothyroidism (adjusted OR[95%CI]: 1.029[1.004-1.054]), intrahepatic cholestasis of pregnancy (adjusted OR[95%CI]: 1.095[1.047-1.146]), term premature rupture of membranes (adjusted OR[95%CI]: 1.044[1.005-1.085]), hypertensive disorders of pregnancy (adjusted OR[95%CI]: 1.030[1.0004-1.060]), gestational thrombocytopenia (adjusted OR[95%CI]: 1.078 [1.045-1.113]), placenta adhesion (adjusted OR[95%CI]: 1.054 [1.027-1.082]), and the duration of hematoma was positively associated with the incidence of term premature rupture of membranes (adjusted OR[95%CI]: 1.070[1.027-1.115]), gestational diabetes mellitus (adjusted OR[95%CI]: 1.938 [1.886-1.993]) and fetal growth restriction (adjusted OR[95%CI]: 1.194 [1.124-1.268]). CONCLUSIONS The presence, size and duration of a first-trimester asymptomatic subchorionic hematoma may be associated with adverse pregnancy outcomes at later gestations such as term premature rupture of membranes and fetal growth restriction.
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Affiliation(s)
- Shuangjia Pan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yehui Lan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Yujia Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Baoyi Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Feifei Zhou
- Department of Obstetrics and Gynecology, the Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, 325000, China
| | - Dongru Dai
- Department of Obstetrics and Gynecology, the Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, 325000, China.
| | - Ying Hua
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
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Ouyang Y, Peng Y, Zhang S, Gong F, Li X. A simple scoring system for the prediction of early pregnancy loss developed by following 13,977 infertile patients after in vitro fertilization. Eur J Med Res 2023; 28:237. [PMID: 37452358 PMCID: PMC10347825 DOI: 10.1186/s40001-023-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
A retrospective study was conducted to investigate a convenient simple scoring system for the prediction of early pregnancy loss (EPL) based on simple demographics. A total of 13,977 women undergoing transvaginal ultrasound scans on Days 27-29 after in vitro fertilization-embryo transfer (IVF-ET) from June 2016 and December 2017 were included. The first trimester pregnancy outcome was recorded at 12 weeks of gestation. The areas under the curve of this scoring system were 0.884 (95% confidence interval (CI) 0.870-0.899) and 0.890 (95% CI 0.878-0.903) in the training set and test set, respectively. The score totals ranged from -8 to 14 points. A score of 5 points, which offered the highest predictive accuracy (94.01%) and corresponded to a 30% miscarriage risk, was chosen as the cutoff value, with a sensitivity of 62.84%, specificity of 98.79%, positive predictive value (PPV) of 88.87% and negative predictive value (NPV) of 94.54% for the prediction of EPL in the training set. In the test set, a score of 5 points had a sensitivity of 64.69%, specificity of 98.78%, PPV of 89.87% and NPV of 93.62%, and 93.91% of the cases were correctly predicted. Therefore, the simple scoring system using conventionally collected data can be conveniently used to predict EPL after ET. However, considering the limitations, its predictive value needs to be further verified in future clinical practice.
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Affiliation(s)
- Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Yangqin Peng
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.
- Clinical Research Center For Reproduction and Genetics in Hunan Province, Changsha, China.
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21
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Mei Y, Lin Y, Guo X, Zhang Y, Wang F. The risk factors and impact of subchorionic hematoma in the first trimester in IVF twin pregnancies: a prospective cohort study. Front Med (Lausanne) 2023; 10:1187344. [PMID: 37448796 PMCID: PMC10337779 DOI: 10.3389/fmed.2023.1187344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Objective This study aimed to identify the risk factors for subchorionic hematoma (SCH) in the first trimester of in vitro fertilization (IVF) twin pregnancies and investigate the impact of SCH on pregnancy outcomes. Study design A prospective cohort study was conducted at Chengdu Women and Children's Central Hospital. The study recruited patients who were identified with twin pregnancies in the first trimester, undergoing IVF treatment from January 2020 to May 2021. The demographic characteristics and pregnancy outcomes were compared between the SCH and the non-SCH groups. A logistic regression analysis was used to determine the risk factors for SCH and adverse pregnancy outcomes. Results In the first trimester, 38% of patients developed SCH. The independent risk factors for SCH included male factor, hydrosalpinx, polycystic ovary syndrome (PCOS), previous miscarriage, and adenomyosis. With respect to the pregnancy outcomes, only the rate of twin pregnancy loss before 20 gestational weeks was significantly higher in the SCH group than in the non-SCH group. After adjusting for the confounding factors, the presence of SCH diminished the ovarian reserve, and previous miscarriage was independently related to twin pregnancy loss before 20 gestational weeks. Conclusion This may be the first study to evaluate the risk factors of SCH in twin pregnancies who underwent IVF-ET/FET treatment, which may provide some theoretical basis for clinical practice in the future. Furthermore, it was found that the occurrence of SCH was associated with the loss of both pregnancies before 20 gestational weeks. Therefore, these patients should be offered increased surveillance and timely treatment.
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22
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Thom C, Kongkatong M, Moak J. The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients. Open Access Emerg Med 2023; 15:207-216. [PMID: 37274422 PMCID: PMC10237201 DOI: 10.2147/oaem.s409920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Ultrasonography has an important role in the evaluation of Emergency Department (ED) patients presenting with early pregnancy complaints. Both transabdominal (TAUS) and transvaginal ultrasound (TVUS) can be utilized. While TVUS generally allows for greater detail, it is unclear how much added benefit exists in performing TVUS once an intrauterine pregnancy (IUP) has been identified on TAUS. Methods This was a retrospective study utilizing Radiology Department ultrasound examinations obtained in first trimester pregnancy ED patients during a consecutive four month period in 2019. Studies wherein both TAUS and TVUS were both performed were included. Two ED physicians with specialized training in point of care ultrasound reviewed only the TAUS images from these studies. Their findings were compared to the Radiologist interpretation, which was inclusive of both TAUS and TVUS components of the study. Results 108 studies met inclusion criteria. Amongst these, 82 had IUP's identified on the radiologist report. 69 studies had an IUP identified by ED physician review of the TAUS images, with 1 false positive. Each case of intrauterine fetal demise (IUFD) was identified on ED physician review of TAUS. Two ectopic pregnancies were present, neither of which was mistaken for IUP on ED physician TAUS review. There were 15 studies with subchorionic hemorrhage and 3 studies with an ovarian cyst noted on the radiologist report. Conclusion Following the identification of an IUP on TAUS, the added diagnostic value of TVUS amongst this cohort of ED patients was low. Given the added time and cost of TVUS, selective instead of routine usage should be encouraged.
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Affiliation(s)
- Christopher Thom
- Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthew Kongkatong
- Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - James Moak
- Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
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23
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Elmas B, Özgü BS, Zorlu U, Koç BL, Ozdemir EU, Akkaya SK, Akay A, Öztürk N, Erkaya S. Do First-Trimester Subchorionic Hematomas Affect Pregnancy Outcomes? Z Geburtshilfe Neonatol 2023; 227:31-35. [PMID: 36170877 DOI: 10.1055/a-1929-9500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the relationship between first trimester subchorionic hematomas and pregnancy outcomes in women with singleton pregnancies. MATERIAL AND METHODS Between January 2018 and January 2019, patients who had a single pregnancy between the 6th and 14th weeks of their pregnancy and were hospitalized with the diagnosis of abortus imminens in the early pregnancy service were included in the study. According to the ultrasonographic examination, those with subchorionic hematoma and those with no hematoma were compared in terms of demographic data, pregnancy outcomes and pregnancy complications. RESULTS 400 abortus immines cases with subchorionic hematoma and 400 abortus imminens cases without subchorionic hematoma were compared. Preterm delivery percentages were similar in both groups, however abortus percentage was significantly higher in the hematoma group (34.2 vs. 24.7%; p=0.007). In addition, it was revealed that the presence of subchorionic hematoma before the 20th gestational week increased the risk of miscarriage 1.58 times. However, no data could be found in the study that could correlate the size of the hematoma with pregnancy loss. CONCLUSION The presence of subchorionic hematoma increases abortion rates in abortus imminens cases. And the presence of subchorionic hematoma in cases with ongoing pregnancy does not increase the complications of delivery.
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Affiliation(s)
- Burak Elmas
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Burçin Salman Özgü
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Uğurcan Zorlu
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Bergen Laleli Koç
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Eda Ureyen Ozdemir
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Selver Kübra Akkaya
- Department of Gynecology and Obstetrics, Ankara Şehir Hastanesi, Cankaya, Turkey
| | - Arife Akay
- Department of Gynecology and Obstetrics, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
| | - Neslihan Öztürk
- Department of Gynecology and Obstetrics, Kırıkkale yüksek ihtisas hastanesi, Kırıkkale, Turkey
| | - Salim Erkaya
- Department of Gynecology and Obstetrics, Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey
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King SA, Salerno A, Sommerkamp S. Ultrasound in Pregnancy. Emerg Med Clin North Am 2023; 41:337-353. [PMID: 37024168 DOI: 10.1016/j.emc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This article reviews the use of ultrasound in pregnancy pertinent to the emergency physician. The techniques for transabdominal and transvaginal studies are detailed including approaches to gestational dating. Diagnosis of ectopic pregnancy is reviewed focusing on the potential pitfalls: reliance on beta-human chorionic gonadotropin, pseudogestational sac, interstitial pregnancy, and heterotopic pregnancy. Techniques for the identification of placental issues and presenting parts during the second and third trimesters are reviewed. Ultrasound is a safe and effective tool for the experienced emergency physician and is integral to providing high-quality care to pregnant women.
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Subchorionic hematoma and risk of preterm delivery: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100791. [PMID: 36328350 DOI: 10.1016/j.ajogmf.2022.100791] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between early pregnancy with subchorionic hematoma and preterm delivery and other adverse pregnancy outcomes in singleton pregnancies. DATA SOURCES English studies published from 2000 to July 15, 2022 were retrieved from PubMed, Web of Science, and the Cochrane Library. STUDY ELIGIBILITY CRITERIA The inclusion criteria were: singleton pregnancy, subchorionic hematoma, and perinatal outcomes. Studies including multiple pregnancy, basic molecular studies, case reports (series), and conference reviews were excluded. METHODS Data analysis was mainly conducted with Review Manager (RevMan) and Stata, and the results were represented with odds ratios and 95% confidence intervals. The methodological quality of the included studies was evaluated by the Cochrane risk assessment scale. RESULTS In total, 370 studies were retrieved from the above databases. Our review included 16 studies and divided them into 2 subgroups: natural pregnancy (12 studies) and assisted reproductive pregnancy (4 studies). The relevant characteristics of each study were analyzed in detail. The primary outcome was preterm delivery. The secondary outcomes were miscarriage, fetal growth restriction, cesarean delivery, and preeclampsia. We found that subchorionic hematoma in the first trimester was not significantly associated with preterm delivery (odds ratio, 1.11; 95% confidence interval, 0.82-1.51) or other adverse outcomes in singleton pregnancy. Regression analysis found that the large heterogeneity of the included studies might be related to whether the included study population (early pregnancy with subchorionic hematoma) was complicated with threatened abortion (P<.05). However, no studies caused large heterogeneity according to sensitivity analysis. Finally, 15 studies related to preterm delivery did not have publication bias (Egger test: P=.26). However, subchorionic hematoma in the first trimester was associated with miscarriage in single pregnancies (natural pregnancy: odds ratio, 3.07; 95% confidence interval, 1.98-4.75; assisted reproductive pregnancy: odds ratio, 1.45; 95% confidence interval, 1.1-1.90). CONCLUSION In singleton pregnancy, we found no association between subchorionic hematoma in the first trimester and preterm delivery. Although there was a correlation with miscarriage, the possible gestational age of miscarriage was not stated. More studies are needed to further address the herein posed research questions.
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Inman ER, Miranian DC, Stevenson MJ, Kobernik EK, Moravek M, Schon SB. Outcomes of subchorionic hematoma-affected pregnancies in the infertile population. Int J Gynaecol Obstet 2022; 159:743-750. [PMID: 35212401 PMCID: PMC9790669 DOI: 10.1002/ijgo.14162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the implications of an incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile population. METHODS Retrospective cohort study at a tertiary care, university-based facility. All patients with intrauterine pregnancy on initial obstetric ultrasound presenting to an infertility clinic between January 2015 and March 2018 (n = 1210), regardless of treatment cycle, were included. Nonviable pregnancies were excluded. The main outcome measured was association between subchorionic hematoma and first trimester miscarriage. RESULTS The prevalence of subchorionic hematoma was 12.5% (n = 151) and did not differ by type of fertility treatment. There was no association between subchorionic hematoma and first trimester miscarriage; however, among patients with subchorionic hematoma, those who reported both bleeding and cramping had an increased probability of miscarriage compared to those without symptoms (0.62 vs. 0.12, P <0.001). The live birth rate in this sample was 81.3% and there were no statistically significant differences in pregnancy outcomes between those with and without subchorionic hematoma. CONCLUSION Among an infertile population, there was no increased risk of miscarriage when subchorionic hematoma was seen on early ultrasound; however, when patients noted both vaginal bleeding and cramping, their probability of miscarriage was significantly increased.
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Affiliation(s)
- Erin R. Inman
- Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichiganUSA
| | - Daniel C. Miranian
- Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichiganUSA
| | | | - Emily K. Kobernik
- Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichiganUSA
| | - Molly B. Moravek
- Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichiganUSA
| | - Samantha B. Schon
- Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichiganUSA
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27
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Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review. Obstet Gynecol Surv 2022; 77:745-752. [PMID: 36477386 DOI: 10.1097/ogx.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Importance Subchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion. Objective The aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. Results There were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported. Conclusions Subchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion. Relevance Subchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.
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28
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Xu C, Wang W, Yang B, Zhu M. Subchorionic Hematoma Volume Measured by Virtual Organ Computer-Aided Analysis in the Prediction of First-Trimester Pregnancy Outcome. Ultrasound Q 2022; 38:291-296. [PMID: 36223480 DOI: 10.1097/ruq.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT This study aimed to assess the association of subchorionic hematoma (SCH) size measured by virtual organ computer-aided analysis (VOCAL) with the first-trimester pregnancy outcome. A total of 139 first-trimester pregnancies from 6 to 12 weeks of gestational age with SCH were included. The circumference, area, and volume of the SCH (Cs, As, and 3DVs) and gestational sac (Cg, Ag, and 3DVg) were automatically calculated by VOCAL. Interobserver agreement was assessed with the intraclass correlation coefficient and Bland-Altman plot. Odds ratios for the clinical and ultrasound characteristics of adverse pregnancy outcomes were estimated by univariate or multivariable logistic regression. There was high interobserver agreement in VOCAL measurements of the SCH and gestational sac (intraclass correlation coefficients, >0.900). By univariate regression analysis, women with adverse pregnancy outcomes were more likely to have vaginal bleeding, a larger As and 3DVs, and higher Cs/Cg, As/Ag, and 3DVs/3DVg ratios (all P < 0.05). In the multivariable regression analysis, a higher 3DVs/3DVg ratio of SCH (odds ratio, 1.034; 95% confidence interval [CI], 1.015-1.053; P = 0.000) and vaginal heavy bleeding had a significant positive relationship with the risk of adverse pregnancy outcomes (odds ratio, 7.846; 95% CI, 1.104-55.737; P = 0.039) remained associated with an increased risk of adverse pregnancy outcomes. With 11.87% as the cutoff, the receiver operating characteristic curve yielded a good predictive performance (area under the curve, 0.713) and high sensitivity (91.18%). The measurements of SCH by VOCAL provide high reliability for estimating the total hematoma burden in first-trimester pregnant patients. A greater volume proportion (3DVs/3DVg) of SCH worsens the pregnancy outcome, and a greater risk of adverse pregnancy outcome also associated with the severity of vaginal bleeding.
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Affiliation(s)
- Chaoli Xu
- Department of Ultrasound Diagnostics, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Wenrong Wang
- Ultrasound Department, Lianyungang Maternal and Child Health Hospital, Lianyungang
| | - Bin Yang
- Department of Ultrasound Diagnostics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China
| | - Minmin Zhu
- Ultrasound Department, Lianyungang Maternal and Child Health Hospital, Lianyungang
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Doubilet PM, Phillips CH, Durfee SM, Benson CB. Fourfold Improved Odds of a Good First Trimester Outcome Once a Yolk Sac Is Seen in Early Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2835-2840. [PMID: 35225369 DOI: 10.1002/jum.15971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To compare first trimester prognosis when an early pregnancy sonogram demonstrates a gestational sac with yolk sac versus gestational sac without yolk sac. METHODS Our study comprised 823 transvaginal sonograms without identifiable embryo performed at least 35 days from last menstrual period (LMP), in which mean sac diameter was <16 mm and first trimester outcome (live or early pregnancy loss) was known. We recorded the presence or absence of yolk sac, first trimester outcome, and several clinical features: maternal age, time since LMP, and presence or absence of vaginal bleeding. We compared the likelihood of a successful first trimester outcome in cases with a visible yolk sac to those without a yolk sac. RESULTS At the end of the first trimester, 113 of 270 (41.9%) cases without a yolk sac and 414 of 553 (74.9%) with a yolk sac were live (P < .000001, chi-square). This corresponds to an odds ratio of 4.14 for the presence of yolk sac, a result confirmed by logistic regression. Advanced maternal age, ≥42 days since LMP, and vaginal bleeding all carried an increased risk of loss (P < .000001, chi-square). Outcome was better with a visualized yolk sac than without a yolk sac, regardless of number of risk factors (P < .001, chi-square). CONCLUSIONS The odds of successful first trimester outcome are 4-fold higher when a yolk sac is seen on an early pregnancy sonogram than when no yolk sac is seen. For any level of risk, based on maternal age, vaginal bleeding, and time since LMP, outcome is significantly better when a yolk sac is seen.
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Affiliation(s)
- Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherine H Phillips
- Department of Radiology, Vanderbilt University Medical Center, Vanderbilt Medical School, Nashville, TN, USA
| | - Sara M Durfee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Yin R, Wang K, Li L, Dang Y, Wang B, Sheng Y, Ma Z, Sun M. Association between first-trimester subchorionic hematoma detected at 6–8 weeks of gestation and pregnancy outcomes after fresh embryo transfers: a propensity score-matching cohort study. Arch Gynecol Obstet 2022; 306:2167-2175. [DOI: 10.1007/s00404-022-06775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto-Torres EE, Tirosh D, Jaiman S, Johnson A. Doppler evaluation of normal and abnormal placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:28-41. [PMID: 34806234 DOI: 10.1002/uog.24816] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M F Bartal
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Jaiman
- Department of Obstetrics and Gynecology Wayne State University, Detroit, MI, USA
| | - A Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Qin ZJ, Xu Y, Du Y, Chen YL, Sun L, Zheng A. Intrauterine Hematoma in the First Trimester and Pregnancy Complications: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:892146. [PMID: 35783643 PMCID: PMC9247277 DOI: 10.3389/fmed.2022.892146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Studies evaluating the relationship between intrauterine hematoma in the first trimester and prenatal complications are conflicting. Objectives To evaluate whether intrauterine hematoma identified in the first trimester in women with singleton pregnancies is associated with adverse perinatal outcomes. Search Strategy A comprehensive literature search of three databases (Embase, PubMed, and Web of Science) was performed up to September 2021. Selection Criteria Cohort and case-control studies that have evaluated the relationship between intrauterine hematoma identified before 14 gestational weeks and the risk of prenatal complications, in women with a singleton pregnancy. Data Collection and Analysis Two members of our team independently assessed the studies for inclusion, collected the data of interest, and assessed the risk of bias, and calculated pooled odds ratios (ORs) using random-effects models. Main Results Nine studies, including 1,132 women with intrauterine hematoma and 11,179 controls met the inclusion criteria. Intrauterine hematoma increased the risk of spontaneous abortion [OR 2.15, 95% confidence interval (CI) 1.23–3.75], preterm birth (OR 1.83, 95% CI 1.37–2.43), fetal growth restriction (OR 2.33, 95% CI 1.13–4.83) and placental abruption (OR 3.16, 95% CI 1.23–8.13). No statistically significant association was found between intrauterine hematoma and preeclampsia (OR 1.30, 95% CI 0.87–1.94). Conclusion Intrauterine hematoma in the first trimester of pregnancy increases the risk of spontaneous abortion, preterm birth, placental abruption, and fetal growth restriction. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Zhao-juan Qin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Yu Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Yi Du
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ya-li Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Liang Sun
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
- *Correspondence: Ai Zheng
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Rajput MZ, Mellnick VM. The Role of Magnetic Resonance in Evaluating Abdominopelvic Trauma - Part 2: Trauma in Pregnancy, Vascular, and Genitourinary Injuries. Can Assoc Radiol J 2022; 73:689-696. [PMID: 35282712 DOI: 10.1177/08465371221077654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Trauma is an important cause of mortality, particularly in the young. While computed tomography (CT) is the mainstay of body imaging in the setting of trauma, magnetic resonance (MR) imaging can be useful in stable patients. Although more commonly used in spinal and musculoskeletal trauma, MR also has a role in abdominopelvic trauma. Broadly, its uses include clarification of equivocal cases, monitoring complications of trauma, particularly with solid organ injury, or as a primary imaging modality for patients with low suspicion for injury for whom avoiding ionizing radiation is a priority-namely, in pediatric and pregnant patients. In this two-part review article, we will review clinical scenarios where this may be encountered, utilizing case examples. Our second installment will focus on the use of MR in pregnant patients and in the characterization of vascular and genitourinary trauma. Body MR can be useful in pregnant patients in characterizing injuries both specific for and not specific for pregnancy. Placental injuries and hematomas in particular may be better seen on MR relative to CT, owing to its superior contrast resolution. MR angiography can be performed either without or with contrast and can be useful to monitor low-grade traumatic aortic injuries. Renal and ureteral injuries can be followed with MR to help identify urine leaks, either in a delayed presentation or in patients who have an iodinated contrast allergy. Lastly, penile injuries are often imaged with ultrasound, but may benefit from additional imaging with MR when the tunica albuginea cannot be completely seen due to overlying hematoma.
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Affiliation(s)
- Mohamed Z Rajput
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, 116142Washington University School of Medicine, St Louis, MO, USA
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Aki M, Katsumata M, Yamanoi K, Ueda A, Nakakita B, Tani H, Kawasaki K, Chigusa Y, Mogami H, Mandai M, Kondoh E. The significance of clinical symptoms of subchorionic hematomas, “bleeding first”, to stratify the high-risk subgroup of very early preterm delivery. Taiwan J Obstet Gynecol 2022; 61:243-248. [DOI: 10.1016/j.tjog.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
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Ge Y, Lai S, Li X, Shi J, Ma C, Zhao J. Vanishing twin syndrome is associated with first-trimester intrauterine hematoma in twin pregnancies after in vitro fertilization. Front Endocrinol (Lausanne) 2022; 13:1062303. [PMID: 36714561 PMCID: PMC9880446 DOI: 10.3389/fendo.2022.1062303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
RESEARCH QUESTION Is there an association between intrauterine hematoma (IUH), vanishing twin syndrome (VTS), and subsequent complications in twin pregnancies after in vitro fertilization (IVF)? What are the risk factors for these complications? DESIGN Women who presented with two live gestational sacs following double embryo transfer were included. Patients with systematic diseases, artificial fetal reduction, and incomplete data were excluded. Further stratification of IUH pregnancies was performed according to IUH-related characteristics (i.e., volume, changing pattern, and relationship with fetal cardiac activities). The primary outcome was the incidence of VTS, while adverse outcomes in the surviving singleton and the gestational age of VTS were secondary outcomes. RESULTS The incidence of IUH was 13.8%. A total of 1,078 twin pregnancies including 539 IUH pregnancies and 539 non-IUH pregnancies were included. IUH pregnancy was associated with higher risks of VTS (26.9% vs. 18.7%, p = 0.001) as well as a higher incidence of preterm birth (p = 0.001, crude OR = 1.98, 95% CI 1.28-3.09, adjusted OR = 1.19, 95% CI 1.09-1.24), threatened abortion (p < 0.001, crude OR = 9.12, 95% CI 2.90-28.69, adjusted OR = 6.63, 95% CI 1.69-14.67), and postpartum hemorrhage (p = 0.024, crude OR = 3.13, 95% CI 1.09-8.99, adjusted OR = 1.16, 95% CI 1.08-1.32) in the surviving singleton. There was no significant difference in risks of other complications. The absence of fetal cardiac activities at the diagnosis of IUH predicted VTS (p < 0.001, crude OR 4.67, 95% CI 3.67-5.78, adjusted OR 3.33, 95% CI 1.56-5.14) and fetal loss at smaller gestational age (7.81 ± 2.10 vs. 11.39 ± 5.60 weeks, p < 0.001), while an IUH with an increasing volume did not increase the risk of VTS but might induce threatened abortion in the surviving fetus (p < 0.001, crude OR 1.84, 95% CI 1.32-2.55, adjusted OR 1.72, 95% CI 1.13-2.13). CONCLUSIONS IUH was a risk factor for VTS in twin pregnancies following double embryo transfer and elevated the risks of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. The absence of fetal cardiac activities at the diagnosis of IUH elevated the risks of VTS, while an IUH with an increasing volume was associated with threatened abortion without elevating the risks of VTS. An IUH diagnosed before the presence of fetal cardiac activities also resulted in an earlier miscarriage. The study suggests that attention be paid to twin pregnancies with first-trimester IUH to prevent VTS and subsequent adverse perinatal outcomes. HIGHLIGHTS First-trimester intrauterine hematoma (IUH) following double embryo transfer is associated with a higher incidence of vanishing twin syndrome (VTS) and elevated subsequent risk of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. Other perinatal outcomes were not associated with the diagnosis of first-trimester IUH. The absence of fetal cardiac activities at the diagnosis of IUH was of predictive value toward VTS, while an IUH with an increasing size was associated with threatened abortion without elevating the risk of VTS. Incomplete fetal cardiac activities and earlier detection of an IUH might also predict miscarriage at smaller gestational age.
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Affiliation(s)
- Yimeng Ge
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Shaoyang Lai
- Department of Obstetrics, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoxue Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
| | - Jing Shi
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
- *Correspondence: Jie Zhao, ; Caihong Ma,
| | - Jie Zhao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China
- *Correspondence: Jie Zhao, ; Caihong Ma,
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Li Y, Wang E, Huang S, Zhu C, Zhang K, Zhang J, Xu H, Shu J. Autoantibodies in association with subchorionic haematoma in early pregnancy. Ann Med 2021; 53:841-847. [PMID: 34085897 PMCID: PMC8183528 DOI: 10.1080/07853890.2021.1936150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/22/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the possible aetiology of subchorionic haematoma (SCH), especially its association with autoantibodies. MATERIAL AND METHODS Early pregnant women who were detected SCH through ultrasonography were identified as the study group and those without SCH at comparable ages who visited the clinic at the same period of time were compared as the control group. Indexes of laboratory immune tests were compared between the two groups, as well as their pregnancy outcomes. RESULTS A total of 97 SCH patients and 130 control cases were recruited in this study. A higher proportion of women was detected autoantibodies in the SCH group compared with control group (45.36% vs 21.54%, p = .000). Positive rates of ANA (24.74% vs 10.77%, p = .005) and laboratory antiphospholipid antibodies (ACL, anti-β2 GP1 or LA) (25.77% vs 11.54%, p = .005) showed significant differences between the two groups. The incidence of vaginal bleeding was significantly higher in the SCH group (43.30% vs 20.00%, p = .000). While the miscarriage rates were not significantly different (17.53% vs 15.38%, p = .666). And there were no significant differences in terms of preterm delivery rate, caesarean section rate, birth weight and pregnancy complications. Most SCHs (96.25%) were absorbed before 20th gestational week. In the SCH group, the average birth weight was significantly lower in women with autoantibodies. Clinical features and other pregnancy outcomes showed no significant differences between SCH patients with and without autoantibodies. CONCLUSIONS The occurrence of SCH may be associated with autoantibodies. The pregnancy outcomes were comparable between women with and without SCH.KEY MESSAGESSubchorionic haematoma (SCH) is increasingly commonly observed in early pregnancy period, but the aetiology is uncertain and the clinical significance of SCH is controversial.The occurrence of SCH may be associated with autoantibodies.The pregnancy outcomes were not significantly different between women with and without SCH.
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Affiliation(s)
- Yang Li
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Ensheng Wang
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Shisi Huang
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Changling Zhu
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Kemei Zhang
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Jiaou Zhang
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Haiyan Xu
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
| | - Jing Shu
- Reproductive Medicine Center, Ningbo First Hospital, Ningbo, China
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Anderson KL, Jimenez PT, Omurtag KR, Jungheim ES. Outcomes of in vitro fertilization pregnancies complicated by subchorionic hematoma detected on first-trimester ultrasound. F S Rep 2021; 1:149-153. [PMID: 34223231 PMCID: PMC8244369 DOI: 10.1016/j.xfre.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To estimate the association between subchorionic hematoma (SCH) on ultrasound and pregnancy outcomes in in vitro fertilization (IVF) pregnancies. Design Institutional Review Board–approved, retrospective cohort study. Setting Tertiary care university-based facility. Patient(s) In this study, 1,004 patients who underwent IVF with a viable singleton pregnancy from January 1, 2009 through December 31, 2017. Intervention(s) Subchorionic hematoma versus no hematoma diagnosed on first-trimester ultrasound. Main Outcome Measure(s) Live birth, preterm birth, and spontaneous abortion. Result(s) We found that 1,004 women met the criteria and 187 (18.6%) had an SCH. In bivariate and multivariate regression models, there were no associations between SCH and the outcomes of live birth, preterm birth, or birth weight. Conclusion(s) Subchorionic hematoma detected on first-trimester ultrasound after IVF is not associated with probability of live birth, probability of preterm birth, or infant birth weight in this patient population.
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Affiliation(s)
- Kelsey L Anderson
- Division of Reproductive Endocrinology and Infertility, Washington University Obstetrics and Gynecology, St. Louis, Missouri
| | - Patricia T Jimenez
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
| | - Kenan R Omurtag
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
| | - Emily S Jungheim
- Division of Reproductive Endocrinology and Infertility, Northwestern University Obstetrics and Gynecology, Chicago, Illinois
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Comparison of Obstetric and Neonatal Results and Subchorionic Hematoma Area Effects of Pregnant Women with Abortus Imminence and Healthy Pregnant Women. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2021. [DOI: 10.21673/anadoluklin.861511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Naqvi M, Naert MN, Khadraoui H, Rodriguez AM, Namath AG, Ali M, Fox NS. Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies. Am J Perinatol 2021; 38:779-783. [PMID: 31887747 DOI: 10.1055/s-0039-3401852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study estimates the association of a first trimester finding of subchorionic hematoma (SCH) with third trimester adverse pregnancy outcomes in women with twin pregnancies. STUDY DESIGN Retrospective cohort study of twin pregnancies prior to 14 weeks at a single institution from 2005 to 2019, all of whom had a first trimester ultrasound. We excluded monoamniotic twins, fetal anomalies, history of fetal reduction or spontaneous reduction, and twin-to-twin transfusion syndrome. Ultrasound data were reviewed, and we compared pregnancy outcomes after 24 weeks in women with and without a SCH at their initial ultrasound 60/7 to 136/7 weeks. Regression analysis was used to control for any differences in baseline characteristics. RESULTS A total of 760 women with twin pregnancies met inclusion criteria for the study, 68 (8.9%) of whom had a SCH. Women with SCH were more likely to have vaginal bleeding and had their initial ultrasound at earlier gestational ages. On univariate analysis, SCH was not significantly associated with gestational age at delivery, preterm birth, birthweight of either twin, low birthweight percentiles of either twin, fetal demise, or preeclampsia. SCH was associated with placental abruption on univariate analysis, but not after controlling for vaginal bleeding and gestational age at the time of the initial ultrasound (adjusted odds ratio: 2.00, 95% confidence interval: 0.63-6.42). Among women with SCH, SCH size was not associated with adverse pregnancy outcomes. CONCLUSION In women with twin pregnancies, the finding of a first trimester SCH is not associated with adverse pregnancy outcomes >24 weeks.
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Affiliation(s)
- Mariam Naqvi
- Maternal Fetal Medicine Associates, PLLC, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Hanaa Khadraoui
- Touro College of Osteopathic Medicine, Harlem, New York, New York
| | | | - Amalia G Namath
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Munira Ali
- Touro College of Osteopathic Medicine, Harlem, New York, New York
| | - Nathan S Fox
- Maternal Fetal Medicine Associates, PLLC, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York
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Molecular Changes on Maternal-Fetal Interface in Placental Abruption-A Systematic Review. Int J Mol Sci 2021; 22:ijms22126612. [PMID: 34205566 PMCID: PMC8235312 DOI: 10.3390/ijms22126612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022] Open
Abstract
Placental abruption is the separation of the placenta from the lining of the uterus before childbirth. It is an infrequent perinatal complication with serious after-effects and a marked risk of maternal and fetal mortality. Despite the fact that numerous placental abruption risk factors are known, the pathophysiology of this issue is multifactorial and not entirely clear. The aim of this review was to examine the current state of knowledge concerning the molecular changes on the maternal–fetal interface occurring in placental abruption. Only original research articles describing studies published in English until the 15 March 2021 were considered eligible. Reviews, book chapters, case studies, conference papers and opinions were excluded. The systematic literature search of PubMed/MEDLINE and Scopus databases identified 708 articles, 22 of which were analyzed. The available evidence indicates that the disruption of the immunological processes on the maternal–fetal interface plays a crucial role in the pathophysiology of placental abruption. The features of chronic non-infectious inflammation and augmented immunological cytotoxic response were found to be present in placental abruption samples in the reviewed studies. Various molecules participate in this process, with only a few being examined. More advanced research is needed to fully explain this complicated process.
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Uomoto M, Obata S, Yumoto A, Nakanishi S, Sasahara Y, Otani M, Miyagi E, Aoki S. A case of successful pregnancy in a septate uterus after discharge of decidual tissue in the second trimester. Clin Case Rep 2021; 9:2382-2384. [PMID: 33936699 PMCID: PMC8077306 DOI: 10.1002/ccr3.4042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
In pregnant patients with a divided uterine cavity, the decidual tissue on the nonpregnant side may be discharged prior to the delivery of the fetus. The pregnancy can continue if the uterine contractions and vaginal bleeding are controlled and the fetus is not in distress.
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Affiliation(s)
- Mari Uomoto
- Perinatal Center for Maternity and NeonatesYokohama City University Medical CenterYokohamaJapan
| | - Soichiro Obata
- Perinatal Center for Maternity and NeonatesYokohama City University Medical CenterYokohamaJapan
| | - Ami Yumoto
- Perinatal Center for Maternity and NeonatesYokohama City University Medical CenterYokohamaJapan
| | - Sayuri Nakanishi
- Perinatal Center for Maternity and NeonatesYokohama City University Medical CenterYokohamaJapan
| | - Yukiko Sasahara
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
| | - Masako Otani
- Department of PathologyYokohama City University Medical CenterYokohamaJapan
| | - Etsuko Miyagi
- Department of Obstetrics and GynecologyYokohama City University HospitalYokohamaJapan
| | - Shigeru Aoki
- Perinatal Center for Maternity and NeonatesYokohama City University Medical CenterYokohamaJapan
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Narciso TARM, Hoshida MS, Costa PR, Niquirilo A, Biancolin SE, Lin LH, Francisco RPV, Brizot ML. Fetal-Maternal Hemorrhage in First-Trimester Intrauterine Hematoma. Fetal Diagn Ther 2021; 48:227-234. [PMID: 33706316 DOI: 10.1159/000513747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare the frequency and percentage of fetal hemoglobin (HbF%) by flow cytometry of (1) first-trimester asymptomatic patients with intrauterine hematoma (IUH), (2) first-trimester pregnant patients with vaginal bleeding (VB), and (3) first-trimester asymptomatic pregnant women without hematoma. METHODS Prospective study involving pregnant women in the first trimester of pregnancy. Patients with ultrasound findings of asymptomatic hematoma and with VB were paired with asymptomatic pregnant women of same gestational age without hematoma (control group [CG]). Maternal blood HbF% was evaluated by flow cytometry. The groups were compared in terms of circulating fetal hemoglobin and HbF%. RESULTS Sixty-six patients were selected, 22 with hematoma, 17 with bleeding, and 27 in the CG. Fetal hemoglobin was detected in 15 patients with hematoma (68.2%) and 13 with bleeding (76.5%) and in 20 of the control (74.1%) (p = 0.830). The mean HbF% of each group was 0.054, 0.012, and 0.042 for hematoma, bleeding, and control, respectively, and differences were not significant (p = 0.141). There was a moderate negative correlation between the volume of hematoma and HbF% (rSpearman = -0.527; p = 0.012). CONCLUSIONS The fetal-maternal hemorrhage expressed by Hbf% in first-trimester pregnancies did not seem to differ between patients with and without ultrasound findings of IUH.
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Affiliation(s)
- Thaisa A R M Narciso
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mara S Hoshida
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscilla R Costa
- Division of Clinical Immunology and Allergy/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andrea Niquirilo
- Division of Clinical Immunology and Allergy/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sckarlet E Biancolin
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lawrence H Lin
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rossana P V Francisco
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria L Brizot
- Department of Obstetrics and Gynecology/Faculdade de Medicina FMUSP/Universidade de Sao Paulo, Sao Paulo, Brazil,
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Ji W, Hou B, Li W, Guo F, He P, Zheng J. Associations between first-trimester intrauterine hematoma and twin pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:46. [PMID: 33430833 PMCID: PMC7802326 DOI: 10.1186/s12884-020-03528-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background In recent years, first-trimester intrauterine hematoma (IUH) has become increasingly common in twin pregnancy. The majority of studies on IUH have excluded twin pregnancies, and others did not differentiate between singleton and twin pregnancies. The impact of IUH on twin pregnancy is unclear. Therefore, the primary objective of our study was to examine associations between first-trimester IUH and pregnancy outcomes in twin pregnancies. Methods The data of 1020 twin pregnancies in women who received a routine examination from January 2014 to December 2018 were reviewed. We compared baseline data and pregnancy outcomes between those with and without IUH. Multivariable logistic regression analysis was used to adjust for possible confounding factors. Results A total of 209 patients (21.3%) developed IUH in the first trimester. First-trimester IUH was significantly associated with increased odds of miscarriage (adjusted odds ratio 14.27, 95% CI 8.25–24.70) and vanishing twin syndrome (adjusted odds ratio 3.26, 95% CI 1.11–4.61). However, there were no differences in the rates of stillbirth, preeclampsia, preterm labor (< 34 weeks), low birth weight, postpartum hemorrhage or fetal distress between the two groups. Maternal age, previous preterm birth, chorionicity in twins and the gestational week at first ultrasound did not differ between the two groups. The women with IUH had high rates of previous miscarriage (46.73% vs 38.37%, p = 0.01), assisted conception (48.56% vs 32.60%, p < 0.001) and accompanied vaginal bleeding (67.46% vs 13.43%, p < 0.001). According to the logistic regression analyses, these characteristics were not associated with pregnancy loss or vanishing twin syndrome. No IUH characteristics, including volume, largest diameter, or the presence of vaginal bleeding, were associated with pregnancy loss or vanishing twin syndrome before 20 weeks of gestation (P > 0.05). Conclusion In women with twin pregnancy, the presence of IUH in the first trimester was associated with the loss of one or both fetuses before 20 weeks of gestation. However, previous miscarriage, the conception method, the IUH size and the presence of vaginal bleeding were not independently associated with miscarriage or vanishing twin syndrome.
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Affiliation(s)
- Wanqing Ji
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong Province, China
| | - Bo Hou
- Departments of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, China
| | - Weidong Li
- Department of Woman and Child Health Information Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Fang Guo
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong Province, China
| | - Ping He
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong Province, China.
| | - Jie Zheng
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong Province, China.
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Yue M, Ma L, Cao Y, Zhai J. Application of a Nomogram for Predicting the Risk of Subchorionic Hematoma in Early Pregnancy With In Vitro Fertilization-Embryo Transfer/Frozen Embryo Transfer. Front Endocrinol (Lausanne) 2021; 12:631097. [PMID: 33737911 PMCID: PMC7961085 DOI: 10.3389/fendo.2021.631097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subchorionic hematoma (SCH) is common in early pregnancy achieved by in vitro fertilization-embryo transfer/frozen embryo transfer (IVF-ET/FET), and is associated with adverse obstetric outcomes. However, there are no methods known to accurately predict the occurrence of SCH. OBJECTIVE To establish a nomogram prediction model for predicting the risk of SCH in early pregnancy with IVF-ET/FET and to analyze pregnancy outcomes of patients with SCH. METHODS Patients who underwent IVF-ET/FET treatment and were diagnosed with clinical pregnancy were enrolled in our study. A total of 256 patients with SCH were enrolled in the SCH group, and 526 patients without SCH in the control group. Logistic regression was used to screen risk factors for SCH, and the nomogram was developed according to the regression coefficient of relevant variables. Discrimination, effect, calibration, and the predictive model's clinical usefulness were assessed using the C-index, the area under the receiver operating characteristic standard curve, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. The effects of SCH on pregnancy outcomes were analyzed. RESULTS A multivariate logistic regression analysis showed that fresh embryo transfer, polycystic ovary syndrome, hydrosalpinx, and thin endometrium were risk factors affecting the occurrence of SCH. Based on the above factors, a predictive model for the risk of SCH was created. The model displayed good discrimination, with a C-index of 0.783 (95% confidence interval: 0.750-0.816), area under the receiver operating characteristic standard curve of 0.783, and good calibration. A high C-index value of 0.765 could still be reached in the interval validation. Decision curve analysis showed that the nomogram was clinically useful when the intervention was decided at the SCH possibility threshold of 4%-87%. For patients with successful deliveries, the occurrence of SCH did not influence the gestational weeks of delivery, mode of delivery, preterm birth, height, and weight of the newborn. CONCLUSION We screened the risk factors for SCH in patients who underwent IVF-ET/FET treatment. Successful establishment of a nomogram can effectively predict the occurrence of SCH. Furthermore, the incidence of miscarriage is higher in patients with SCH.
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Affiliation(s)
- Ma Yue
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linna Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yurong Cao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jun Zhai,
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Shaamash AH, Aly HA, Abdel-Aleem M, Akhnowkh SN. Clinical and Ultrasound Evaluation of Early Threatened Miscarriage to Predict Pregnancy Continuation up to 28 Weeks: A Prospective Cohort Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1777-1785. [PMID: 32314402 DOI: 10.1002/jum.15282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES (1) To study the predictors of pregnancy continuation up to 28 weeks in first-trimester threatened miscarriage after a single clinical and ultrasound (US) evaluation. (2) To assess the role of both clinical and US predictors in counseling and decreasing repeated emergency follow-up scans. METHODS A prospective observational study that included a cohort of 241 patients with threatened miscarriage (≥6-12 weeks) was conducted. They had a single clinical and US evaluation, and then they were contacted by weekly phone calls until completing 28 weeks' gestation or reporting miscarriage. Independently, all patients were followed by the recommended routine US scanning with or without emergency visits. RESULTS Two hundred thirty-three patients completed the study, of whom 193 patients continued up to 28 weeks' gestation, and 40 miscarried (17.1%). Only spotting/mild bleeding episodes and progesterone treatment were the clinical predictors of fetal viability. The embryonic/fetal heart rate (E/FHR) was the best single US predictor, with a specificity and positive predictive value of 95.3% and 97.2%, respectively. Combining 3 US parameters, at their best cutoff points (E/FHR >113 beats per minute, crown-rump length >19.9 mm, and gestational sac diameter >27.3 mm), had a specificity and positive predictive value of 98% and 99% (first-trimester US triad of fetal viability). CONCLUSIONS [1] In first-trimester threatened miscarriage, clinical parameters that could predict fetal viability included spotting/ mild bleeding and progesterone treatment. [2] After a single US scan, the presence of at least an E/FHR of greater than 113 bpm or the suggested first-trimester US triad appeared as a simple, measurable, and effective predictor of pregnancy continuation up to 28 weeks. [3] These US predictors are not to replace the recommended scheduled scanning during pregnancy. [4] This can improve patients' counseling and decrease the need for repeated emergency follow-up scans. Otherwise, there is an indication for repeating US scans at a 1-week to 10-day interval.
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Affiliation(s)
- Ayman H Shaamash
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hany A Aly
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud Abdel-Aleem
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Seham N Akhnowkh
- Department of Obstetrics and Gynecology, El-eman Hospital, Ministry of Health, Assiut, Egypt
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Le Gallee M, Lee S, Spence AR, Czuzoj-Shulman N, Klam S, Abenhaim HA. Association Between First-Trimester Bleeding and Retained Placenta Requiring Dilatation and Curettage. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:463-468. [PMID: 33153944 DOI: 10.1016/j.jogc.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Early subchorionic hemorrhage may lead to a disruption in the placental-uterine matrix, which may result in an adherence of the placenta to the endometrium. We evaluated the effect of a first-trimester bleed on the need for a post-vaginal delivery dilatation and curettage (D&C) for removal of retained placenta. METHODS We conducted a case-control study at a tertiary care centre between 2012 and 2016. Patients identified through medical records as having required a post-vaginal delivery D&C for retained placenta were considered cases and were matched 1:5 with patients delivering vaginally within 1 week who did not require a D&C. History of first-trimester bleeding and subchorionic hemorrhage were identified through chart review. Conditional logistic regression analyses estimated the effect of a first-trimester bleed on the requirement for D&C for retained placenta. Models were adjusted for maternal age and previous uterine surgery. RESULTS There were 68 cases of retained placenta requiring D&C, for an estimated 3 in 1000 deliveries. Patients requiring D&C were slightly older than controls but were otherwise comparable with respect to baseline demographic characteristics. In adjusted analyses, patients who required a postpartum D&C were more likely than controls to have had a first-trimester bleed at 11.8% and 0.6%, respectively (OR 25.3; 95% CI 4.7-135.4, P < 0.001). Postpartum D&C for retained placenta was associated with postpartum hemorrhage, need for blood transfusion, and manual removal of placenta. CONCLUSION First-trimester bleeding should be considered a high-risk determinant for post-vaginal delivery D&C for retained placenta and for severe postpartum hemorrhage.
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Affiliation(s)
- Marissa Le Gallee
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Seohyuk Lee
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC
| | - Stephanie Klam
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC.
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So S, Mochizuki O, Yamaguchi W, Murabayashi N, Miyano N, Tawara F. Impact of subchorionic hematoma in early pregnancy on obstetric complications: A retrospective cohort study in women who had live births after frozen-thawed embryo transfer. Reprod Med Biol 2020; 19:398-403. [PMID: 33071642 PMCID: PMC7542017 DOI: 10.1002/rmb2.12343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose We investigated the contribution of subchorionic hematoma (SCH) involvement in early pregnancy to the risk of pregnancy complications in women who underwent frozen‐thawed embryo transfer (FET). Methods A hypoechogenic area surrounding the gestational sac at early pregnancy on ultrasound was defined as SCH. Simultaneously, the presence of vaginal bleeding was evaluated. We included 1416 women with live births after FET between March 2015 and September 2018 in this study. The frequency of pregnancy complications was compared between the SCH (n = 340) and non‐SCH (n = 1076) groups. Results The adjusted odds ratio of abnormal placental adhesion and placenta previa for the SCH group relative to the non‐SCH group was 7.01 [2.96‐18.00] and 3.77 [1.24‐11.91], respectively. In contrast, hypertensive disorders of pregnancy, non‐reassuring fetal status, fetal growth restriction, chorioamnionitis, and premature rupture of the membrane showed no differences between both groups. Furthermore, the frequency of abnormal placental adhesion was higher in the SCH group with vaginal bleeding than in the SCH group without vaginal bleeding. Conclusions Subchorionic hematoma in early pregnancy may cause abnormal placental adhesion and placenta previa in pregnant women with FET. SCH presence should be carefully noted, particularly in cases with vaginal bleeding during early pregnancy after FET. Subchorionic hematoma in early pregnancy may cause abnormal placental adhesion and placenta previa in pregnant women with frozen embryo transfer. SCH presence should be carefully noted, particularly in cases with vaginal bleeding during early pregnancy after frozen embryo transfer.
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Affiliation(s)
- Shuhei So
- Department of Reproductive and Perinatal Medicine Hamamatsu University School of Medicine Shizuoka Japan.,Tawara IVF Clinic Shizuoka Japan
| | | | | | - Nao Murabayashi
- Department of Reproductive and Perinatal Medicine Hamamatsu University School of Medicine Shizuoka Japan.,Tawara IVF Clinic Shizuoka Japan
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Suttorp CM, van Rheden REM, van Dijk NWM, Helmich MPAC, Kuijpers-Jagtman AM, Wagener FADTG. Heme Oxygenase Protects against Placental Vascular Inflammation and Abortion by the Alarmin Heme in Mice. Int J Mol Sci 2020; 21:ijms21155385. [PMID: 32751152 PMCID: PMC7432719 DOI: 10.3390/ijms21155385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022] Open
Abstract
Both infectious as non-infectious inflammation can cause placental dysfunction and pregnancy complications. During the first trimester of human gestation, when palatogenesis takes place, intrauterine hematoma and hemorrhage are common phenomena, causing the release of large amounts of heme, a well-known alarmin. We postulated that exposure of pregnant mice to heme during palatogenesis would initiate oxidative and inflammatory stress, leading to pathological pregnancy, increasing the incidence of palatal clefting and abortion. Both heme oxygenase isoforms (HO-1 and HO-2) break down heme, thereby generating anti-oxidative and -inflammatory products. HO may thus counteract these heme-induced injurious stresses. To test this hypothesis, we administered heme to pregnant CD1 outbred mice at Day E12 by intraperitoneal injection in increasing doses: 30, 75 or 150 μmol/kg body weight (30H, 75H or 150H) in the presence or absence of HO-activity inhibitor SnMP from Day E11. Exposure to heme resulted in a dose-dependent increase in abortion. At 75H half of the fetuses where resorbed, while at 150H all fetuses were aborted. HO-activity protected against heme-induced abortion since inhibition of HO-activity aggravated heme-induced detrimental effects. The fetuses surviving heme administration demonstrated normal palatal fusion. Immunostainings at Day E16 demonstrated higher numbers of ICAM-1 positive blood vessels, macrophages and HO-1 positive cells in placenta after administration of 75H or SnMP + 30H. Summarizing, heme acts as an endogenous “alarmin” during pregnancy in a dose-dependent fashion, while HO-activity protects against heme-induced placental vascular inflammation and abortion.
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Affiliation(s)
- Christiaan M. Suttorp
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6525 EX Nijmegen, The Netherlands; (C.M.S.); (R.E.M.v.R.); (N.W.M.v.D.); (M.P.A.C.H.)
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - René E. M. van Rheden
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6525 EX Nijmegen, The Netherlands; (C.M.S.); (R.E.M.v.R.); (N.W.M.v.D.); (M.P.A.C.H.)
| | - Natasja W. M. van Dijk
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6525 EX Nijmegen, The Netherlands; (C.M.S.); (R.E.M.v.R.); (N.W.M.v.D.); (M.P.A.C.H.)
| | - Maria P. A. C. Helmich
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6525 EX Nijmegen, The Netherlands; (C.M.S.); (R.E.M.v.R.); (N.W.M.v.D.); (M.P.A.C.H.)
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University of Groningen and University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta ID-10430, Indonesia
| | - Frank A. D. T. G. Wagener
- Department of Dentistry—Orthodontics and Craniofacial Biology, Radboud University Medical Center, 6525 EX Nijmegen, The Netherlands; (C.M.S.); (R.E.M.v.R.); (N.W.M.v.D.); (M.P.A.C.H.)
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-36-18824
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Comparison of subchorionic hematoma in medicated or natural single euploid frozen embryo transfer cycles. Fertil Steril 2020; 114:595-600. [PMID: 32709380 DOI: 10.1016/j.fertnstert.2020.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the effect of frozen embryo transfer (FET) preparation protocol on incidence of subchorionic hematoma (SCH) and serum hormone levels. DESIGN Retrospective cohort study. SETTING University-affiliated fertility center. PATIENT(S) Patients who underwent FET at the New York University Langone Fertility Center. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcome was incidence of SCH by protocol in FET cycles. RESULT(S) There were 1,273 FET cycles that met criteria for inclusion. The frequency of SCH was lower in natural compared with programmed cycles (P<.05; relative risk = 0.4 [0.27-0.78]; odds ratio = 0.4 [0.23-0.75]). Serum estrogen level was higher in programmed compared with natural cycles on day of progesterone initiation (P<.001) and cycle day 28 (P<.001). However, serum estrogen levels at the same time points were not associated with formation of SCH in programmed or natural cycles. CONCLUSION(S) This is the first study to evaluate the formation of SCHs by FET protocol type. Our results highlight that high serum estradiol levels do not independently lead to an increase in rate of SCH. Further research must be done to understand other clinical, or perhaps molecular, differences between natural and programmed FET cycle preparations that can be better associated with SCH formation.
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Liu Y, Tong A, Qi X. A large subchorionic hematoma in pregnancy: A case report. Medicine (Baltimore) 2020; 99:e20280. [PMID: 32481396 DOI: 10.1097/md.0000000000020280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Subchorionic hematoma (SCH) is a rare type of intrauterine hematoma, usually with limited impact on fetuses and pregnant women. But massive hematoma causes significant space occupying effect, affects blood supply of the fetus and finally may lead to fetus demise. PATIENT CONCERNS In this case report, we reported a 22-year-old pregnant woman presented to our hospital with complaint of irregular lower abdominal pain. DIAGNOSIS Ultrasonography and magnetic resonance imaging confirmed an intrauterine mass with a compressed growth-restricted fetus. INTERVENTIONS The patient underwent diseases induced labor after confirmation of fetus demise by ultrasonography. OUTCOMES Histopathological examination of the mass revealed a SCH. CONCLUSION Though small SCH can be found in quite a few pregnant women and is usually harmless, enormous hematoma can result in adverse pregnancy outcomes. It may be difficult, in some cases, to differentiate it from uterine tumors or placental tumors by means of ultrasonography and magnetic resonance imaging, especially when the mass is hyperechoic under ultrasonography. This case report stresses the importance of regular examinations of pregnant women.
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Affiliation(s)
- Yu Liu
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - An Tong
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital
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