Subchorionic Hematoma (Pendarahan dalam kehamilan)

FROM : http://www.ncbi.nlm.nih.gov/pmc/articles/ http://www .ncbi.nlm.nih.gov/pmc/articles/PMC42852!/ PMC42852!/ "# $ational %ibrar& o' Me(icine $ational )nstit*tes o' +ealth

 , -*r -*r er &necol 0ssoc. 0ssoc. 214 534: 2!6242. 2!6242. P*blishe( online 214 7ec . (oi: 1.552/tgga.214.491 PMC)7: PMC42852! The efects o subchorionic hematoma on pregnancy outcome in patients with threatened abortion

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Abstract

o to: Introduction

aginal blee(ing is a 'reG*ent complication o' pregnanc& (*ring the Hrst trimester? with an inci(ence o' IJ625J 3 3. )ntra*terine blee(ing witho*t cervical (ilatation an( ten(erness (*ring the earl& pregnanc& perio( is (eHne( as threatene( abortion. enerall&? it is not associate( with pain an( eKcessive blee(ing. -hese blee(ings res*lt in maternal anKiet& an( ma& be associate( with 'etal/maternal 'etal/maternal a(verse o*tcomes 332 264. One o' the s*ggeste( mechanisms 'or threatene( abortion is placental (&s'*nction? which can also ca*se several late complications? s*ch as preeclampsia? preterm preterm labor? preterm preterm birth? placental abr*ption? placenta previa? intra*terine growth restriction? restriction? an( perinatal mortalit& 32? !. #imilarl&? ins*Lcient angiogenesis is associate( with earl& pregnanc& losses? an( maternal ser*m 0FP an( NhC are s*ggeste( to be *se( as marers o' angiogenesis in the Hrst trimester 35 35. -ogether with these marers? chronic inammation o' the (eci(*a might also be the *n(erl&ing ca*se o'  earl& pregnanc& blee(ings. 3Per(arahan vagina mer*paan ompliasi &ang sering ehamilan selama trimester pertama? (engan ea(ian IJ N25J 3. Per(arahan Per(arahan intra*terin tanpa (ilatasi servis (an n&eri selama perio(e awal ehamilan (i(eHnisian sebagai terancam aborsi. "m*mn&a? hal ini ti(a terait (engan rasa sait (an per(arahan &ang berlebihan. Per(arahan Per(arahan ini

mengaibatan ecemasan ib* (an m*ngin terait (engan / hasil &ang mer*gian ib* anin 314/12. #alah sat* meanisme &ang (isaranan *nt* mengancam aborsi a(alah (is'*ngsi plasenta? &ang *ga (apat men&ebaban beberapa ompliasi ahir? seperti preelamsia? persalinan premat*r? elahiran premat*r? sol*sio plasenta? plasenta previa? pembatasan pert*mb*han intra*terin? (an ematian perinatal 32? !. 7emiian p*la? ti(a c**p angiogenesis berh*b*ngan (engan er*gian awal ehamilan? (an 0FP ser*m ib* (an NhC (isaranan *nt* (ig*naan sebagai penan(a angiogenesis pa(a trimester 35 pertama. ersamaNsama (engan tan(a terseb*t? pera(angan ronis (ari (esi(*a  *ga m*ngin mena(i pen&ebab &ang men(asari per(arahan awal ehamilan. )ntra*terine hemorrhages are commonl& observe( 'eat*res on *ltraso*n( eKaminations? especiall& among patients with clinicall& evi(ent blee(ing in earl& pregnanc&? an( the inci(ence has been reporte( to be 4J622J 3I. #*bchorionic hematomas 3#C+s *s*all& appear as h&poechoic or anechoic crescentNshape( areas on *ltrasonograph&. 0ltho*gh the eKact etiolog& is *ncertain? the& are believe( to res*lt 'rom partial (etachment o' the chorionic membranes 'rom the *terine wall 39. "terine mal'ormations? histor& o' rec*rrent pregnanc& loss? an( in'ections are the possible pre(isposing 'actors 3861. -he clinical signiHcance o' #C+ remains controversial 364. )t is also not certain i' these hemorrhages res*lt in abortion. +owever? accor(ing to the res*lts o' a recent metaN anal&sis? the presence o' #C+ increases the ris o' earl& or late pregnanc& loss b& 2N'ol( 35. )t is s*ggeste( that the presence o' #C+ increases the ris o' an a(verse obstetric o*tcome? an( 'etal o*tcome is associate( with the si;e o' the hematoma? maternal age? an( gestational age 3I? 9.  -he aim o' the present retrospective cohort st*(& was to assess the eects o' *ltrasonographicall& (etecte( #C+ on pregnanc& o*tcomes in patients with vaginal blee(ing within the Hrst hal' o' pregnanc&. 3Per(arahan intra*terin biasan&a (iamati Ht*r pa(a pemerisaan "#? ter*tama (i antara pasien (engan per(arahan terb*ti secara linis pa(a awal ehamilan? (an insi(en terseb*t telah (ilaporan 4J N22J 3I. +ematoma s*borioni 3#C+# biasan&a m*nc*l sebagai (aerah berbent* b*lan sabit h&poechoic ata* anechoic pa(a *ltrasonograH. Mesip*n etiologi sebenarn&a ti(a pasti? merea (i&aini hasil (ari (etasemen parsial (ari membran orioni (ari (in(ing rahim 39. Mal'ormasi *ter*s? riwa&at eg*g*ran ber*lang? (an in'esi mer*paan 'ator pre(isposisi m*ngin 31/8. #igniHansi linis (ari #C+ masih ontroversial 34/. +al ini *ga ti(a &ain apaah per(arahan terseb*t mengaibatan aborsi. $am*n? men*r*t hasil metaNanalisis ini? eha(iran

#C+ meningatan risio eg*g*ran awal ata* ahir oleh 2 ali lipat 35. 7isaranan bahwa eha(iran #C+ meningatan risio hasil obstetri &ang mer*gian? (an hasil anin berh*b*ngan (engan **ran hematoma? *sia ib*? (an *sia ehamilan 3I? 9.  -**an (ari penelitian ohort retrospeti' ini a(alah *nt* menilai e'e (ari *ltrasonograH ter(etesi #C+ pa(a hasil ehamilan pa(a pasien (engan per(arahan vagina (alam par*h pertama ehamilan. o to: Material and Methods

)n this retrospective cohort st*(&? patients with threatene( abortion 3nQ242 who were 'ollowe( at a *niversit&Nbase( perinatolog& clinic between ,an*ar& 211 an( 7ecember 211 were recr*ite(. -he st*(& was approve( b& the instit*tional review boar( o' 0nara "niversit& #chool o' Me(icine. -he incl*sion criteria were hospitali;ation (*e to threatene( abortion? singleton pregnanc&? gestational age 21 wees? an( being 'ollowe( *p at o*r clinic *ntil the en( o' the pregnanc&. -he eKcl*sion criteria were a (iagnosis o' incipient abortion? no 'etal car(iac activit&? gestational age S21 wees? m*ltiple pregnanc&? an( rec*rrent pregnanc& loss. -he st*(& gro*p consiste( o' 44 patients with #C+s observe( on *ltrasonograph&? an( the control gro*p consiste( o' 8 patients witho*t #C+s. 0ll incl*(e( patients were hospitali;e( 'or at least ! (a&s 'ollowing the Hrst vaginal blee(ing episo(e. 0ll patients were a(ministere( proph&lactic progesterone treatment in oral 3Progestan caps*le BoAa Farma? Tstanb*l? -*re&? vaginal 3Crinone 8J gel #erono? Tstanb*l?  -*re&? or intram*sc*lar 3Prol*ton (epot amp*le #chering 0lman? Tstanb*l? -*re& 'orms. #*bseG*ent to (ischarge 'rom the hospital? patients went on ro*tine antenatal 'ollowN*p programs. -he pregnanc& o*tcomes were compare( between the st*(& an( control gro*ps. )n patients whose pregnancies res*lte( in miscarriage? the gestational age at miscarriage an( the (*ration between the Hrst blee(ing an( miscarriage were compare(. )n patients whose pregnancies res*lte( in (eliver&? gestational age at labor? birth weight? preterm (eliver&? an( cesarean section rates were compare( between the gro*ps.

37alam st*(i ini ohort retrospeti'? pasien (engan aborsi terancam 3n Q 242 &ang (ii*ti (i seb*ah lini Perinatologi berbasis *niversitas antara  ,an*ari 211 (an 7esember 211 (irer*t. #t*(i ini (iset**i oleh (ewan penina* elembagaan 0nara "niversit& #chool o' Me(icine. Briteria inl*si a(alah rawat inap arena aborsi terancam? ehamilan t*nggal? *sia ehamilan 21 mingg*? (an (itin(alan*ti (i lini ami sampai ahir ehamilan. Briteria esl*si a(alah (iagnosis aborsi bar* a(i? ti(a a(a

ativitas ant*ng anin? *sia ehamilan S21 mingg*? ehamilan gan(a? (an eg*g*ran ber*lang. Belompo st*(i ter(iri (ari 44 pasien (engan #C+# (iamati pa(a *ltrasonograH? (an elompo ontrol ter(iri (ari 8 pasien tanpa #C+#. #em*a pasien termas* (irawat (i r*mah sait selama seti(an&a ! hari setelah pertama vagina episo(e per(arahan. #em*a pasien (iberian pengobatan progesteron proHlasis oral 3aps*l Progestan Boca Farma? Tstanb*l? -*ri? vagina 3Crinone 8J gel #erono? Tstanb*l? -*ri? ata* intram*s*lar 3Prol*ton (epot amp*l #chering 0lman? Tstanb*l? -*ri bent* . #etelah (ebit (ari r*mah sait? pasien melan*tan program tin(a lan*t antenatal r*tin. +asil ehamilan (iban(ingan antara elompo st*(i (an ontrol. Pa(a pasien &ang ehamilan mengaibatan eg*g*ran? *sia ehamilan (i eg*g*ran (an (*rasi antara per(arahan pertama (an eg*g*ran (iban(ingan. Pa(a pasien &ang ehamilan mengaibatan pengiriman? *sia ehamilan saat persalinan? berat lahir? elahiran premat*r? (an tingat operasi caesar (iban(ingan antara elompo. Statistical analysis

#tatistical Pacage 'or the #ocial #ciences 3#P## 5.1 'or Uin(ows 3Chicago? )%? "#0 was *se( 'or all statistical anal&ses. #hapiroNUil test was *se( to test the (istrib*tion o' normalit&. 0ccor(ing to the res*lts? nonNparametric tests were pre'erre(. Contin*o*s variables were compare( with Br*salNUallis test. Categorical variables were compare( with chiN sG*are test or FisherVs eKact test where appropriate. 0 p val*e o' .15 was consi(ere( statisticall& signiHcant. o to: Results

 -he inci(ence o' #C+ among patients with threatene( abortion was 8.2J 344/242 'or this pop*lation. -he (emographic variables o' the st*(& an( control gro*ps are presente( in -able . -he mean ages o' the patients with an( witho*t #C+ were 2.5WI.2 an( 2.1W5.5 &ears? respectivel& 3pQ.I24. -he gro*ps were comparable regar(ing previo*s parit& an( miscarriage histories 3 -able . #imilarl&? the gro*ps were comparable regar(ing gestational age at the Hrst vaginal blee(ing 3.!W2.8 vs. 1.2W!.! wees? respectivel& pQ.185.

 -able 

7emographic parameters o' the st*(& an( control gro*ps  -able 2 s*mmari;es the parameters o' both gro*ps regar(ing miscarriage ! o' 44 pregnancies with #C+ res*lte( in miscarriage 32.5J? while 25 o' 8 pregnancies with #C+ res*lte( in miscarriage 32.IJ 3pQ.11.  -he gestational age at miscarriage was similar between the st*(& an( control gro*ps 31.8W!.I vs. 1.W4.8 wees? respectivel& pQ.58. #imilarl&? there was no statisticall& signiHcant (ierence between the st*(& an( control gro*ps regar(ing (*ration between the Hrst vaginal blee(ing an( miscarriage 3I.4W2!.8 vs. .1W9.5 (a&s? respectivel& pQ.4!I.

 -able 2 Comparison o' miscarriage an( relate( parameters between st*(& an( control gro*ps #C+: s*bchorionic hematoma  -able 2 Comparison o' miscarriage an( relate( parameters between st*(& an( control gro*ps  -able ! s*mmari;es the pregnanc& o*tcomes o' 214 patients whose pregnanc& res*lte( in (eliver&. -he mean gestational ages at (eliver& were !9.4W4. wees in ! patients with #C+ an( !9.4W!.I wees in 9! patients witho*t #C+ 3pQ.I2. -here was no statisticall& signiHcant (ierence between the st*(& an( control gro*ps regar(ing preterm birth rate 3I.J vs. 25.4J? respectivel& pQ.!I2. #imilarl&? the birth weights were comparable between the gro*ps 3258W81 g vs. !114W9I! g? respectivel& pQ.92. -he cesarean section rates were also similar between the st*(& an( control gro*ps 34.J vs. 45.J? respectivel& pQ.91.

 -able !

Comparison o' pregnanc& o*tcomes in patients whose pregnanc& res*lte( in (eliver& o to: Discussion

 -he res*lts obtaine( 'rom the present st*(& reveale( that the presence o' #C+ in patients with threatene( abortion is an important 'actor 'or the contin*ation o' pregnanc&. -he presence o' #C+ in patients with threatene( abortion increases the ris o' miscarriage. +owever? it (oes not aect the gestational age at miscarriage or the (*ration between the Hrst blee(ing an( miscarriage. )n patients whose pregnancies res*lte( in (eliver&? gestational age at labor? birth weight? preterm (eliver&? an( cesarean section rates were not aecte( b& the presence o' #C+. Previo*sl&? several st*(ies have investigate( the eects o' #C+ on pregnanc& o*tcomes. all et al. 38 eval*ate( 2!8 patients with *ltrasonographicall& (etecte( #C+ in a retrospective casecontrol st*(& an( reporte( a signiHcant association between #C+ an( miscarriage an( preterm (eliver& rates. -he& also reporte( increasing pregnanc& loss rates with increasing #C+ si;e. #imilarl& $ag& et al. 3 compare( 89 patients who ha( #C+ with I488 controls? an( the& 'o*n( increase( miscarriage? intra*terine growth restriction? an( preterm (eliver& rates in the presence o' #C+. +owever? the& 'aile( to show an association between the si;e an( location o' the #C+ an( ongoing pregnanc& o*tcome meas*res. )n a retrospective cohort st*(&? $orman et al. 321 eval*ate( I!?II patients who ha( an *ltrasonographic eval*ation be'ore 22 wees o' gestation an( reporte( that the inci(ence o' #C+ was .9J. -he& 'o*n( that the (etection o' an #C+ (*ring ro*tine secon(Ntrimester *ltrasonograph& was associate( with more than a 2N'ol( increase( ris o' placental abr*ption? regar(less o' whether the woman reporte( blee(ing in the earl& hal' o' pregnanc&. -he& also i(entiHe( that women with #C+ were at increase( ris o' preterm (eliver&. +owever? in the a'orementione( st*(ies? #C+s were (eHne( (*ring the ro*tine HrstN or secon(Ntrimester *ltrasonograph&? an( not all patients with an #C+ ha( threatene( abortion. aginal blee(ing occ*rs in 25J o' pregnancies in the Hrst 21 wees? an( hal' o' these res*lt in miscarriage 3I. +ence? it is important to i(enti'& the ris 'actors o' threatene( abortion an( the 'actors that can aect the o*tcome. )n a retrospective cohort trial? enN+aro*sh et al. 32 assesse( 255I pregnant patients who were a(mitte( with vaginal blee(ing (*ring the Hrst 21 gestational wees. -he inci(ence o' #C+ was J. -he& reporte( that gestational age at (iagnosis? si;e o' #C+? an( (*ration o' blee(ing (i( not aect the pregnanc& o*tcome. -he& also reporte( signiHcantl& (ecrease( miscarriage rates with be( rest. +owever? ennett

et al. 39 reporte( that increasing #C+ si;e increases the ris o' miscarriage. )n a prospective cohort st*(&? Pe(ersen an( Mantoni 'ollowe( *p !42 pregnancies with vaginal blee(ing between  to 21 gestational wees? in which 8J ha( #C+ 32. -he& 'o*n( no association between the presence o' #C+ an( miscarriage or preterm (eliver& riss. )n another retrospective caseNcontrol st*(&? ,ohns et al. 322 reporte( that HrstN trimester vaginal blee(ings were associate( with a(verse pregnanc& o*tcomes? b*t the presence o' #C+ ha( no eect on the prognosis. 0ccor(ing to the res*lts o' a recent metaNanal&sis eval*ating 9!5 patients with #C+ 'rom 9 st*(ies? the presence o' #C+ increases the riss o' earl& an( late pregnanc& loss? miscarriage? an( preterm premat*re r*pt*re o' membranes 35. )n a prospective st*(& 'rom -*re&? the si;e o' the #C+ was s*ggeste( to be the primar& ris 'actor 'or miscarriage in patients with HrstNtrimester vaginal blee(ing 32!. "l*E et al. 324 reporte( that HrstNtrimester blee(ings were associate( with preterm (eliver& an( low birth weight. +owever? the& 'o*n( no relationship between the prognosis an( presence or si;e o' the #C+. )n another -*rish caseNcontrol st*(&? D;a&a et al. 325 reporte( the o*tcomes o' 4! patients with #C+? an( the& 'o*n( that the presence o' #C+ increases the riss o' miscarriage an( intra*terine growth restriction b*t not preterm (eliver&. -he res*lts o' o*r st*(& were partiall& concor(ant with the literat*re? as we co*l( onl& show that the presence o'  #C+ increase( the ris o' miscarriage. +owever? we 'aile( to show an& signiHcant relationship between the presence o' #C+ an( ongoing pregnanc& o*tcome meas*res.  -he *n(erl&ing mechanism o' how #C+ ca*ses a(verse pregnanc& o*tcomes is still controversial. One o' the possible mechanisms is the premat*re per'*sion o' the intervillo*s space? as occ*rs with s*bchorionic hemorrhage? be'ore the (evelopment o' placental a(aptations to cope with oKi(ative stress 32I. 0nother possible mechanism might be the *n(erl&ing ca*se o' the s*bchorionic blee(ing an( secon(ar& mechanical eects o' the hematoma. #hallow trophoblast invasion an( impaire( angiogenesis with res*ltant 'riable bloo( vessels ma& pre(ispose one to s*bchorionic hemorrhage? as well as a(verse o*tcomes 35. -he presence o' a hematoma? especiall& in a retroplacental location? ma& create an area o' weaness? where '*rther separation o' the placenta 'rom the *terine wall ma& occ*r? res*lting in placental abr*ption 35. O*r res*lts s*pport the estimate( mechanical eect o' #C+ that can ca*se miscarriage. -he presence o' an #C+ an( (etachment o' the gestational sac 'rom the en(ometri*m ma& res*lt in miscarriage. +owever? i' the gestational sac s*rvives? reattachment to the en(ometrial wall might be

eno*gh 'or '*rther progression o' the pregnanc& witho*t an& other a(verse eects. )n concl*sion? #C+ in patients with threatene( abortion (*ring the Hrst hal' o' the pregnanc& increases the ris o' miscarriage. +owever? it is not absol*te i' the presence o' an #C+ increases the a(verse pregnanc& o*tcome ris in ongoing pregnancies or not? beca*se almost all o' the previo*sl& reporte( st*(ies were retrospective. %arge prospective ran(omi;e( st*(ies are reG*ire( to (etermine the tr*e role o' #C+ in the prognosis o' ongoing pregnancies. o to: Footnotes Ethics ommittee Appro!al"  $/0. Inormed onsent"  $/0. #eer$re!iew" 
.0. #*pervision N .D.? 0.B.? F.#. Reso*rce N .<.=.? .. Materials N .<.=.? .. 7ata CollectionX/or Processing N .<.=.? .. 0nal&sisX/or )nterpretation N .<.=.? .0. %iterat*re #earch N .<.=. Uriting N .<.=. Critical Reviews N .D.? 0.B.? F.#. on%ict o Interest"  $o conict o' interest was (eclare( b& the a*thors. Financial Disclosure" -he a*thors (eclare( that this st*(& has receive(

no Hnancial s*pport. o to: Reerences

. Farrell -? Owen P. -he signiHcance o' eKtrachorionic membrane separation in threatene( miscarriage. r , Obstet &naecol. I1!:2I68. YP*bMe(Z 2. #araswat %? hattachar&a #? Maheshwari 0? hattachar&a #. Maternal an( perinatal o*tcome in women with threatene( miscarriage in the Hrst trimester: 0 s&stematic review. ,O. 2119:245659. YP*bMe(Z !. Ueiss ,%? Malone F7? i(aver ,? all R+? $&berg 70? Comstoc C+? et al.  -hreatene( abortion: a ris 'actor 'or poor pregnanc& o*tcome? a pop*lationNbase( screening st*(&. 0m , Obstet &necol. 21141:9456 51. YP*bMe(Z 4. Uiesiriwar(ana 0? hattachar&a #? #hett& 0? #mith $? hattachar&a #. Obstetric o*tcome in women with threatene( miscarriage in the Hrst trimester. Obstet &necol. 211I19:5596I2. YP*bMe(Z

5. B*tl*er ? [iAe $M? MoraloEl* D?
9. ennett %? romle& ? %ieberman ri&e Blinileri , &necol Obst. 21144:24965. 24. "l*E "? ,o;wia <0? -os*n #? ahAeci M. Preterm (eliver& ris among pregnancies with histor& o' Hrst trimester vaginal blee(ing an( intra*terin hematoma. _e&nep Bamil -\p >lteni. 211I!9:4965. 25. D;a&a
)sr Me( 0ssoc ,. 211! ,*n53I:422N4.

Pregnanc& o*tcome o' threatene( abortion with s*bchorionic hematoma: possible beneHt o' be(Nrest^ enN+aro*sh 0? ogev ? Mashiach R? Mei;ner ). 0*thor in'ormation 0bstract BACKGROUND:

lee(ing in the Hrst trimester o' pregnanc& is a common phenomenon? associate( with earl& pregnanc& loss. )n man& instances a s*bchorionic hematoma is 'o*n( sonographicall&. OBJECTIVE:

 -o eval*ate the possible beneHt o' be(Nrest in women with threatene( abortion an( sonographicall& proven s*bchorionic hematoma? an( to eKamine the possible relationship o' (*ration o' vaginal blee(ing? hematoma si;e? an( gestational age at (iagnosis to pregnanc& o*tcome. METHODS:

 -he st*(& gro*p consiste( o' 2!1 women o' 2?55I 3J re'erre( 'or *ltraso*n( eKamination beca*se o' vaginal blee(ing in the Hrst hal' o' pregnanc&? who were 'o*n( to have a s*bchorionic hematoma in the presence o' a singleton live embr&o or 'et*s. 0ll patients were a(vise( be(Nrest at home 211 a(here( to this recommen(ation 'or the (*ration o'  vaginal blee(ing 3gro*p  an( !1 contin*e( their *s*al li'est&le 3gro*p 2. 0ll were 'ollowe( with repeate( sonograms at 9 (a& intervals *ntil blee(ing cease(? the s*bchorionic hematoma (isappeare(? or abortion occ*rre(. -he gro*ps were compare( 'or si;e o' hematoma? (*ration o' blee(ing? an( gestational age at (iagnosis in relation to pregnanc& o*tcome 3spontaneo*s abortion? term or preterm (eliver&. RESULTS:

 -he Hrst blee(ing episo(e occ*rre( at 2.I /N !.4 wees o' gestation 3range 9N21 wees an( laste( 'or 28.8 /N . (a&s 3range 4N92 (a&s.  -he women who a(here( to be(Nrest ha( 'ewer spontaneo*s abortions 3.J vs. 2!.!J? P Q 1.11I an( a higher rate o' term pregnanc& 38 vs. 91J? P Q 1.114 than those who (i( not. -here was no association between (*ration o' vaginal blee(ing? hematoma si;e? or gestational age at (iagnosis o' s*bchorionic hematoma an( pregnanc& o*tcome.

CONCLUSIONS:

Fewer spontaneo*s abortions an( a higher rate o' term pregnanc& were note( in the be(Nrest gro*p. +owever? the lac o' ran(omi;ation an( retrospective (esign o' the o*tcome (ata collection precl*(e a (eHnite concl*sion. 0 large prospective ran(omi;e( st*(& is reG*ire( to conHrm whether be(Nrest has a real therape*tic eect.

&necol
Pelinesc*NOnci*l 7. Author inormation Abstract

 -he obective o' the st*(& was to eval*ate the eLcac& o' progestogenic therap& 'or the prevention o' spontaneo*s abortions in patients with s*bchorionic hemorrhage. One h*n(re( pregnant women with blee(ing an( *ltrasonographic evi(ence o' s*bchorionic hematoma were treate( with oral (&(rogesterone 41 mg/(a&. Onl& cases in which the embr&o was viable were incl*(e(. -he 'ollowN*p incl*(e( *ltrasonograph& an( intravaginal eKamination. O' the 11 pregnancies? ! ha( a 'avorable evol*tion with maintenance o' pregnanc&. -he abortion rate was there'ore 9J. -his compares with an abortion rate o' 8.9J obtaine( in a previo*s st*(& in women with s*bchorionic hematoma treate( with microni;e( progesterone. -he abortion rate was there'ore re(*ce( b& *p to !9J with (&(rogesterone? as most cases ha( largeNvol*me hematomas at the Hrst visit an( th*s a poor prognosis. )n concl*sion? the mare( imm*nomo(*lator& eect o' (&(rogesterone in maintaining a - helperN2 c&toine balance means that it is a goo( choice 'or preventing abortion in women s*ering 'rom s*bchorionic hemorrhage. 0rticle O*tline ).

Obective

)).

#t*(& 7esign

))).

Res*lts

).

Concl*sion Jump to Section

Obective

#*bchorionic hematoma is associate( with a(verse perinatal o*tcome. Ue so*ght to (etermine both ris 'actors 'or (evelopment o' s*bchorionic hematoma? as well as riss associate( with poor perinatal o*tcomes 'or patients with the con(ition. Jump to Section

#t*(& 7esign Ue per'orme( a caseNcontrol st*(& o' patients seen in the *ltraso*n( *nit at a tertiar& care center between 211! an( 2118. 0 comp*teri;e( (atabase was *se( to i(enti'& patients with *ltraso*n( evi(ence o' a s*bchorionic hematoma. Ue i(entiHe( two controls 'or each case who were the same gestational age an( ha( an *ltraso*n( per'orme( on the same (a&. #tatistical anal&sis was per'orme( with MannNUhitne& " an( Fishers eKact test. 0 pNval*e o' 1.15 was consi(ere( signiHcant. Jump to Section

Res*lts Ue i(entiHe( 9I patients with a s*bchorionic hematoma an( !2 controls. 0ssiste( repro(*ctive technologies 30R- were signiHcantl& associate( with s*bchorionic hematoma. Y2IJ vs J. P1.1Z. +owever? age was not in(epen(entl& associate( with an increase( ris o' s*bchorionic hematoma Ymean W #7 cases:!4.9W5.2 vs.controls: !4.4W 4.5Z. -here was a tren( towar( anticoag*lation being associate( with increase( ris o' hematoma Ycases: I.8J vs. controls: !.4J pQ1.1I9Z.  -he presence o' a hematoma was signiHcantl& associate( with preterm (eliver& 3cases 8J vs controls 9J p1.1 an( PPROM 38J vs !J p1.15. -hese riss were not increase( in patients with a hematoma who ha( vaginal blee(ing compare( to those in which the Hn(ing was inci(ental. -here was no association with )"R however this was an *ncommon o*tcome. F*rthermore? 'or patients with a s*bchorionic hematoma? invasive testing 'or ane*ploi(& was not associate( with an increase in preterm birth or PPROM. Jump to Section

Concl*sion 0R- is a ris 'actor 'or s*bchorionic hematoma. 0ltho*gh the presence o' a s*bchorionic hematoma increases the ris o' preterm birth an( PPROM? patients have a generall& 'avorable o*tcome. iven the ris o' blee(ing with anticoag*lation an( the tren( seen in this st*(&? a prospective st*(& o' this ris 'actor ma& be warrante(.