DOES SUBCHORIONIC HEMATOMA IN THREATENED ABORTION CASES AFFECT THE PREGNANCY OUTCOME?
Yasser Abd Elsalam, Hossam Elbanhawy, Ali Elkassas
Department of Obstetrics and Gynecology, El-Sahel Teaching Hospital, Cairo, Egypt
Background: A subchorionic hematoma is diagnosed as a hypoechoic or anechoic crescent-shaped structure during the ultrasound exam. Although the exact etiology is uncertain, it is believed to be due to a partial detachment of chorionic membranes from the uterine wall. Its clinical significance is still a controversial issue, and it is not sure yet if it could result in abortion or not. Nevertheless, it is suggested that its presence could increase the risk of adverse obstetric outcomes. Intrauterine hemorrhage with an incidence between 4%–22% was observed during ultrasound exams, especially among patients with clinically proven bleeding in early pregnancy. This study aimed to correlate the subchorionic hematoma found during transvaginal ultrasound (TVUS) examination with the miscarriage risk in threatened abortion cases.
Methods: This cohort study was conducted at EL-Sahel Teaching Hospital in 2005 and 2006, including 286 patients with a singleton pregnancy between 6-20 weeks complicated with threatened abortion. They were subjected to TVUS examination and followed up until the end of pregnancy. Patients were divided into two groups: Group A with a subchorionic hematoma on TVUS and Group B without a hematoma. The rate of pregnancy termination and the pregnancy outcome were compared between the two groups.
Result: Miscarriage was observed in 26/88 pregnancies (29.5%) with subchorionic hematoma, and 25/198 pregnancies (12.6%) without subchorionic hematoma resulted (p=0.010). The outcome measures of ongoing pregnancies, such as gestational week at delivery, birth weight, and delivery route, were similar between the groups.
Conclusion: The presence of subchorionic hematoma on ultrasound examination in cases with threatened abortion during the first 20 weeks of gestation increases the risk of miscarriage.