title: Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus' mole).
abstract: OBJECTIVE
  To review the association between ultrasound findings, placental pathology, and prognosis in pregnancies complicated by massive subchorionic thrombohematoma (MTH)/Breus' mole.
  
  
  METHODS
  We identified 14 cases of MTH from January 2004 to December 2012. MTH was defined by >1 cm thickness hematoma and extensive (≥50%) involvement of the fetal surface of the placenta. Patient information, details of initial presentation, and perinatal outcome were obtained from the manual and electronic chart records. Ultrasound findings were related to pregnancy outcomes and associated placental pathology. Participants were stratified on the basis of birth outcome into survivors (live births, n = 7) and nonsurvivors (neonatal deaths or intrauterine fetal deaths/termination of pregnancy, n = 7).
  
  
  RESULTS
  All 14 cases of MTH were suspected on ultrasound and confirmed by pathology assessment. All cases in the nonsurvivor group had abnormal umbilical artery (UA) Doppler waveforms compared with none in the survivors (p = 0.02). All cases in the nonsurvivor group had extreme preterm deliveries (p = 0.02). Birth weight was significantly reduced in the nonsurvivor group (p = 0.001), and 5/7 cases were diagnosed with severe intrauterine growth restriction, compared with none in the survivor group (p = 0.02).
  
  
  CONCLUSIONS
  Massive subchorionic thrombohematoma/Breus' mole may be diagnosed in the second trimester by ultrasound assessment of the placenta. Normal fetal growth and UA Doppler waveforms are associated with perinatal survival.
authors.affiliation: Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
authors.forename: Abdulmohsen
authors.initials: A
authors.lastname: Alanjari
authors.forename: Emily
authors.initials: E
authors.lastname: Wright
authors.forename: Sarah
authors.initials: S
authors.lastname: Keating
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
authors.forename: John
authors.initials: J
authors.lastname: Kingdom
mesh_terms: D000328:Adult; D002823:Chorion / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000473:pathology; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D010922:Placenta Diseases / Q000000981:diagnostic imaging* / Q000473:pathology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods* / Q000706:statistics & numerical data; D014463:Ultrasonography; D055815:Young Adult