Birinci trimester subkoryonik hematom boyutunun 2B ve 3B ultrason ölçüm tekniği ile ölçümünün olumsuz gebelik sonuçlarına etkisi var mıdır?

Year 2019, , 122 - 126, 01.12.2019

Sibel Özler , Başak Gümüş Güler

https://doi.org/10.25000/acem.586513

Abstract

Amaç: Subkoryonik hematom (SKH) boyutunun 2B ve 3B ultrason ile
ölçülmesinin olumsuz gebelik sonuçlarına etkisini değerlendirmeyi amaçladık.

Yöntemler: Yüz elli sekiz SKH olan gebe çalışmaya alındı. SKH tanısı ilk
trimesterde, 6. ve 14. gebelik haftaları arasında, 2 ve 3 boyutlu
ultra-sonografik yöntemlerle konuldu. SKH olan gebelerin düşük, intrauterin
fetal ölüm [IUFÖ] ve preterm doğum [PD] gibi olumsuz gebelik sonuçları
belirlendi. SKH ile düşük, intrauterin fetal ölüm ve erken doğum arasındaki
ilişkiyi belirlemek için lojistik regresyon analizleri yapıldı.

Bulgular: Primipar ve multipar gebeler arasında vücut kitle indexi, 2B ultrasonografik
hematom boyutları, 3B ultrasonografik hematom boyutları ve gebelik sonuçları
açısından istatistiksel olarak anlamlı bir fark yoktu. SKH olan primiparlarda düşük/
IUFÖ hızı %4,6, PD hızı %6,9 ve miad doğum hızı %88,5 idi. SKH olan multiparlarda
ise düşük/ IUFÖ hızı %7, PD hızı %3,5 ve miad doğum hızı %89,5 idi. 2B ve 3B
hematom büyüklüğü ile IUFÖ ve PD arasında anlamlı bir ilişki gözlenmedi.
Lojistik regresyon modelinde ölçüm tekniğinden bağımsız olarak SKH’un ≥500 cm³
olması erken doğumla ilişkili risk faktörü olarak bulundu (OR:1,008, %95 CI: 1,002-1,012,
p=0,006).

Sonuç: SKH boyutunun PD riskini artırdığını belirledik. SKH'un teşhis ve
takibinin 2B ve 3B ultrasonografik ölçüm ile yapılmasının düşük, IUFÖ ve PD
gibi olumsuz gebelik sonuçlarına etkisinin olmadığını gördük. 

Keywords

Subkoryonik Hematom, 3 boyutlu, 2 boyutlu, ultrason, olumsuz gebelik sonuçları

Supporting Institution

Yok

Project Number

approval date/number:05.04.2019/004

Thanks

Çalışmaya dahil olan tüm hastalarımıza teşekkür ederiz.

Does the measurement of the size of the first trimester subchorionic hematoma by 2D and 3D ultrasonographic techniques have any effect on adverse pregnancy outcomes?

Abstract

Aim: We aimed to evaluate whether the measurement of subchorionic
hematoma (SCH) size with 2D and 3D ultrasonography affects adverse pregnancy
outcomes.

Methods: One hundred fifty-eight pregnant patients having SCH were
enrolled in the study. The diagnosis of SCH was made by 2D and 3D
ultra-sonographic methods in the first trimester, between 6^th and 14^th
gestational weeks. Patients having SCH were determined with adverse pregnancy
outcomes such as miscarriage, intrauterine fetal death (IUFD), and preterm
labor (PL). Logistic regression analyses were applied for the relationship of miscarriage,
IUFD, PL, and SCH.

Results: There were no statistically significant differences for body
mass index, 2-D hematoma sizes, 3-D hematoma sizes, and pregnancy outcomes
between the groups. Miscarriage/IUFD rate was 4.6%, PL rate was 6.9%, and the
term delivery rate was 88.5% in the primiparas having SCH. Miscarriage/IUFD
rate was 7%, PL rate was 3.5%, and the term delivery rate was 89.5% in the
multiparas having SCH. No significant association was observed between 2D and
3D hematoma sizes and IUFD and PL. In the logistic regression model, SCH ≥ 500
cm³ was found to be a risk factor associated with PL, not regarding
the measurement technique (OR:1.008, 95% CI: 1.002-1.012, p=0.006).

Conclusion: We determined that SCH size increases the
risk of PL. We observed no effect of diagnosis and follow-up of SCH, by 2D and
3D ultrasonography techniques on adverse pregnancy outcomes such as
miscarriage, IUFD, and PL.

Keywords

Subchorionic Hematoma, three dimensional, two dimensional, ultrasound, adverse pregnancy outcome

Project Number

approval date/number:05.04.2019/004

References

• 1. Mallin M, Dawson M, Schroeder E, Hatch B, Jackson I, Ahern M, et al. Prospective outcomes of pregnant ED patients with documented fetal cardiac activity on ultrasound. Am J Emerg Med. 2012;30:472-5.
• 2. Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynecol Obstet. 1998;63:123–8.
• 3. Maso G, D’Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105:339–44.
• 4. Weiss JL, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Threatened miscarriage: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol. 2004;190:745–50.
• 5. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal Outcomes in Women With Subchorionic Hematoma.Obstet Gynecol. 2011;117:1205-12.
• 6. Brown DL, DiSalvo DN, Frates MC, Davidson KM, Genest DR: Placental surface cysts detected on sonography: Histologic and clinical correlation. J Ultrasound Med. 2002;21:641–6.
• 7. Riccabona M, Nelson TR, Pretorius DH, Davidson TE. In vivo three-dimensional sonographic measurements of organ volume: validation in the urinary bladder. J Ultrasound Med. 1996; 15:627-632.
• 8. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chron Dis. 1972;25:329–43.
• 9. Hartnell GG, Kiely EA, Williams G, Gibson, RN. Real-time ultrasound measurement of bladder volume: a comparative study of three methods.Br J Radiol. 1987;60:1063-5.
• 10. Finch W, Johnston R, Shaida N, Winterbottom A, Wiseman O. Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula? BJU Int. 2014;113:610-4.
• 11. Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102:94–100.
• 12. Zarko Alfirevic, Tamara Stampalija, Nancy Medley. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2017 Jun;2017(6):CD008991.
• 13. Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019;133:400-3.
• 14. Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One. 2014;9:e111676.
• 15. Hashem A, Sarsam SD. The Impact of Incidental Ultrasound Finding of Subchorionic and Retroplacental Hematoma in Early Pregnancy. J Obstet Gynaecol India. 2019;69:43-9.
• 16. Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105:339-44.
• 17. Pedersen JF, Mantoni M. Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences. Br J Obstet Gynaecol. 1990;97:552–3.
• 18. Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound. Obstet Gynecol. 2003;102:483-7.
• 19. Ozkaya E, Altay M, Gelisen O. Significance of subchorionic hemorrhage and pregnancy outcome in threatened miscarriage to predict miscarriage, preterm, and intrauterine growth restriction. J Obstet Gynecol. 2011;31:210–212.
• 20. Ball RH, Ade CM, Schoenborn JA, Crane JP. Significance of ultrasonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996;174:996-1002.
• 21. Li Q, Zhu J, Hua K. Effects of the subchorionic hematoma on pregnancy outcome: a meta-analysis. Zhonghua Yi XueZaZhi. 2016;96:1383-5.
• 22. Peixoto AB, Caldas TMRDC, Petrini CG, Romero ACP Júnior LEB, Martins WP Araujo Júnior E. The impact of the first-trimester intrauterine hematoma on adverse perinatal outcomes. Ultrasonography. 2018;37:330-6.
• 23. Ben-Haroush A, Yogev Y, Mashiach R, Meizner I.Pregnancy outcome of threatened miscarriage with subchorionic hematoma: possible benefit of bed-rest?. Isr Med Assoc J. 2003;5:422-4.
• 24. Hata T, Kanenishi K, Inubashiri E, Tanaka H, Senoh D, Manabe A, Miyake K, et al. Three-dimensional sonographic features of placental abnormalities. Gynecol Obstet Invest. 2004;57:61-5.
• 25. Sharma KA, Das D, Dadhwal V, Deka D, Singhal S, Vanamail P. Two-dimensional fetal biometry versus three-dimensional fractional thigh volume for ultrasonographic prediction of birth weight. Int J Gynecol Obstet. 2019;145:47-53.
• 26. Becsek A, Tzanidakis N, Blanco M, Bollwein H. Transrectal three-dimensional fetal volumetry and crown-rump length measurement during early gestation in mares: Intra- and inter-observer reliability and agreement. Theriogenology. 2019;126:266-71.
• 27. Sadek SM, Ahmad RA, Atia H, Abdullah AG. Towards a more accurate measurement of edge to os distance in low-lying placenta using transvaginal ultrasound: an innovative technique. BMC Pregnancy Childbirth. 2018;18:472.