Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy.
OBJECTIVE
To evaluate the long-term clinical significance of intrauterine hematomas detected in the first trimester of pregnancy in a general obstetric population.


METHODS
A prospective study was designed to compare perinatal outcomes in 187 pregnant women with intrauterine hematomas and 6488 controls in whom hematomas were not detected at first-trimester ultrasonographic examination.


RESULTS
The incidence of intrauterine hematoma in the first trimester in a general obstetric population was 3.1%. A retroplacental position of the hematoma was significantly correlated with an increased risk for adverse maternal and neonatal complications. The presence or absence of symptoms of threatened abortion did not affect these outcomes. The rates of operative vaginal delivery (relative risk [RR] 1.9; confidence interval [CI] 1.1, 3.2) and cesarean delivery (RR 1.4; CI 1.1, 1.8), as well as the rates of pregnancy-induced hypertension (RR 2.1; CI 1.5, 2.9) and preeclampsia (RR 4.0; CI 2.4, 6.7), were significantly greater in the hematoma group. Placental abruption (RR 5.6; CI 2.8, 11.1) and placental separation abnormalities (RR 3.2; CI 2.2, 4.7) were also significantly more frequent in the hematoma group. Perinatal complications, including the rate of preterm delivery (RR 2.3; CI 1.6, 3.2), fetal growth restriction (RR 2.4; CI 1.4, 4.1), fetal distress (RR 2.6; CI 1.9, 3.5), meconium-stained amniotic fluid (RR 2.2; CI 1.7, 2.9), and neonatal intensive care unit admission (RR 5.6; CI 4.1, 7.6), were also significantly increased in this group. Furthermore, the frequency of intrauterine demise and perinatal mortality was increased in the hematoma group, but this difference did not reach statistical significance (Ps =.6 and.2).


CONCLUSIONS
Our study suggests that the presence of an intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome.
Nagy
Sándor
S
Department of Obstetrics and Gynecology, Petz Aladár County Hospital, Gyor, Hungary. nagys@elender.hu
Bush
Melissa
M
Stone
Joanne
J
Lapinski
Robert H
RH
Gardó
Sándor
S
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D010922:Placenta Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016216:Ultrasonography, Prenatal; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology