Abstract
Introduction: Intrauterine hematomas are common ultrasonographic findings that may be associated with first-trimester bleeding. Serial ultrasonography can detect haematoma characteristics and progression which may have predictive value for a favourable pregnancy outcome.
Material and Methods: This was a prospective study involving pregnant women of 14 weeks or less attending antenatal clinic in Malhotra test tube baby and Maternity centre and Global Rainbow hospital Pvt. Ltd. Agra with chief complaints of vaginal bleeding. 788 cases were screened from Jan 2016—Jan 2018, subchorionic haematoma was identified in 97 cases and these were followed up with serial sonograms till 24 weeks of gestation. The outcome was recorded in terms of haematoma volume, size, site, fetal cardiac activity, relative size with respect to gestational sac, symptom regression and outcome. Results were analyzed.
Results: 61% women with subchorionic hematoma belonged to the age group 21-30 years with a mean gestational age of 9.2 weeks. IVF conceived pregnancies demonstrated a much higher incidence ( 22.78%) which is almost double that observed in non-IVF pregnancies(9.68%). 57.7 % of cases had an anterior location of haematoma and the mean volume being 30+9.2cc. 52.2% cases showed progressive decrease in size with complete resolution of haematoma while 11% had an increase in size. Cases with relative size <20% mostly had a favourable outcome and prognosis worsening with relative size >50%.
Conclusion: Assisted reproductive techniques pose a higher risk for incidence of subchorionic haematoma. A relative size of haematoma>50% is significantly associated with an increased risk of spontaneous abortion. Advanced maternal age and an early gestational age at diagnosis may be considered a risk factor for poor outcomes. Late first or second-trimester bleeding also worsens the prognosis. Position or absolute size did not correlate well to the outcome.
Keywords: Subchorionic hematoma,prognosis,first trimester bleeding.
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Corresponding Author
Dr Nidhi Gupta
4/16 A Bagh Farzana Agra -282002, Uttar Pradesh, India
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DOI: https://dx.doi.org/10.18535/jmscr/v6i10.228
